垂体瘤性质的影像学研究及手术入路选择

宋启星+常佳怡+刘保国+肖罡+朱飚

[摘要] 目的 通过分析垂体瘤患者的影像学信号表现，探讨垂体瘤切除手术的最佳入路，为临床垂体瘤患者的治疗提供参考。 方法 选取我院神经外科2014年12月～ 2017年6月收治的垂体瘤患者60例作为研究对象，所有患者术前均采用磁共振进行检查。 结果 质地软组与质地韧组患者在年龄、性别、病程、病灶大小以及磁共振信号等方面差异无统计学意义（P>0.05），临床功能性与无功能性以及病理功能性与无功能性垂体瘤的T2信号之间差异有统计学意义（P<0.05），其余差异无统计学意义（P>0.05）。质地软组患者中临床功能性和病理功能性垂体瘤占比分别为23.5%和68.6%，而质地韧组患者临床功能性和病例功能性垂体瘤患者分别占比为55.6%和33.3%，两者差异均有统计学意义（χ2=3.864，4.104，P<0.05）。 结论 术前根据磁共振弥散加权成像判断垂体瘤的质地，若质地软则以经鼻手术切除垂体瘤为宜，若质地韧则以开颅手术切除垂体瘤为宜。

[关键词] 垂体瘤；磁共振；影像学；手术入路

[中图分类号] R736.4 [文献标识码] A [文章编号] 2095-0616（2017）20-183-03

Imaging study on the nature of pituitary adenoma and selection of surgical approach

SONG Qixing CHANG Jiayi LIU Baoguo XIAO Gang ZHU Biao

Yuebei People's Hospital of Shaoguan，Shaoguan 512000，China

[Abstract] Objective To explore the best approach of pituitary adenoma resection by analyzing the imaging signals of pituitary adenomas， and to provide reference for the treatment of pituitary adenomas. Methods 60 patients with pituitary tumor from December 2014 to June 2017 in the Department of Neurosurgery of Yuebei people's Hospital were selected as the research objects，and all patients were examined by magnetic resonance imaging before operation. Results There was no significant difference in age，sex，course of disease，lesion size and magnetic resonance signal between patients with soft texture group and tough texture group （P>0.05）.There was significant difference in T2 signal between clinical functional and nonfunctional and pathological functional and nonfunctional pituitary adenomas（P<0.05），and the remaining differences were not statistically significant （P>0.05）.The proportion of clinical functional and pathological pituitary adenomas in soft texture group was 23.5% and 68.6%，respectively，while the proportion of clinical functional and pathological functional pituitary adenomas in patients with tough texture group was 55.6% and 33.3%，respectively，and the differences were statistically significant （c2=3.864，4.104，P<0.05）. Conclusion The texture of pituitary adenoma should be judged before operation according to MR diffusion weighted imaging.If the texture is soft，it is advisable to remove pituitary tumor by nasal surgery.If the texture is tough，pituitary adenoma should be removed by craniotomy.

[Key words] Pituitary adenoma；MRI；Imaging；Surgical approach

垂體瘤是一组从垂体细胞发生的肿瘤，以前叶的腺瘤占大多数，来自后叶者少见[1]。垂体瘤是神经外科常见的颅内良性肿瘤，一般经过手术治疗，常见的手术方法有开颅手术和微创手术[2]。目前随着微创技术的发展，经蝶窦入路的微创手术已经成为首选的治疗方法[3]。影响垂体瘤的手术入路选择的因素包括肿瘤的大小、形状、质地等，而质地是重要因素[4]，但术前肿瘤质地评估具有一定的困难[5]。侵袭性垂体瘤是介于良、恶之间的一种交界性肿瘤，其瘤体呈腺瘤结节样生长，且常侵犯周围结构[6]。endprint

术前对垂体腺瘤质地、侵袭性的准确判断，可作为临床诊断和治疗方案的重要参考[7]。对此……