摘要：

研究背景 垂体柄占位性病变病因广泛，诊断相对困难，鞍上垂体柄占位性病变活检术的临床意义至今仍存争议。目的 探讨内镜下扩大经鼻蝶入路垂体柄占位性病变活检术的临床价值及安全性。方法与结果 采用内镜下扩大经鼻蝶入路采集2011-2017年共16例鞍上垂体柄占位性病变患者病灶组织标本，以脂肪“浴缸塞”式联合带蒂鼻中隔黏膜瓣进行鞍底重建。术后病理学证实生殖细胞瘤10 例、朗格汉斯细胞组织细胞增生症 3 例、淋巴细胞性垂体炎 2 例和颅咽管瘤 1 例。术后除 2 例发生中枢神经系统感染外，无一例出现新发腺垂体功能减退、视力视野损害、脑脊液鼻漏、非计划再次手术或死亡等严重并发症。结论 内镜下扩大经鼻蝶入路鞍上垂体柄占位性病变活检术安全可靠，对明确诊断、制定下一步治疗方案具有重要指导意义，值得广泛推广。 

关键词: 内窥镜, 蝶窦, 垂体, 活组织检查

Abstract:

Background Pituitary stalk occupation can result from various lesions, therefore the diagnosis is difficult to a certain extent. The clinical significance of the biopsy to pituitary stalk occupying lesions on suprasellar region remains controversal. Objective To analyze the value and safety of pituitarys talk biopsy by endoscopic extended transsphenoidal approach in the diagnosis of pituitary stalk occupying lesions. Methods and Results There were 16 patients who received pituitary stalk biopsy by endoscopic extended transsphenoidal approach from 2011 to 2017, and reconstruction of sellar floor was done by bath-plug technique and pedicled nasoseptal flap. Postoperative pathological examination identified germinoma in 10 cases, Langerhans' cell histiocytosis (LCH) in 3 cases, lymphocytic hypophysitis in 2 cases and craniopharyngioma in one case. After operation, 2 patients had central nervous system (CNS) rhinorrhea, while no patient had new hypopituitarism, damage of visual field and eyesight, cerebrospinal fluid (CSF) rhinorrhea, unplanned secondary surgery, death or other serious complications. Conclusions Pituitary stalk biopsy by endoscopic extended transsphenoidal approach is a safe and reliable surgical method which is instructive for patient's diagnosis and treatment plan. It is worth popularizing widely.

Key words:  Endoscopes, Sphenoid sinus, Pituitary gland, Biopsy