经口鼻蝶窦显微切除大型垂体腺瘤  

Transoral-nosal-sphenoidal approach for removal of large pituitary adenomas

作　　者：戴如飞[1] 刘宁[1] 朱风仪[1] 赵春生[1] 周明卫[1] 陈海峰[1] 

机构地区：[1]南京医科大学第一附属医院神经外科,南京市210029

出　　处：《中华显微外科杂志》2004年第2期81-83,i001,共4页Chinese Journal of Microsurgery

基　　金：江苏省科技厅社会发展重点资助项目 (BS2 0 0 0 0 50 )

摘　　要：目的　探讨经口鼻蝶窦显微切除大型垂体腺瘤的手术指征、显微外科操作要点及临床疗效。　方法　自 1998年 5月～ 2 0 0 3年 5月 ,采用经口鼻蝶窦入路切除大型垂体腺瘤 87例 ,对其临床资料进行回顾性总结。　结果　其中 81例肿瘤在手术显微镜下全切除 ,全切除率为 93 %,次全切除 6例。术后脑脊液鼻漏 7例 ,其中 1例继发颅内感染死亡 ,其余经治疗后痊愈。全部病例随访 2～ 60个月(平均 3 8 6个月 ) ,手术全切除的病例目前均无复发 ,次全切除的 2例分别于术后 40个月和 5 6个月复发。　结论　垂体腺瘤手术疗效取决于肿瘤的切除程度 ;经口鼻蝶窦入路显微切除大型垂体腺瘤是一种安全有效的方法 ,手术病例的选择和显微手术技巧是肿瘤能否全切除的关键因素。Objective To introduce the indications,microsurgical technique and outcomes of the transoral-nosal-sphenoidal approach for microsurgical removal of large pituitary adenomas. Methods From May 1998 to May 2003,a total of consecutive 87 patients suffering from large pituitary adenomas were removed via transoral-nosal-sphenoidal approach and the clinical data were retrospectively reviewed. Results The gross total removal in 81 patients (93%),and subtotal removal in 6 patients (7%).Complication included CSF leak in 7cases and of the 7 cases,one was dead because of the intrainfection caused by CSF leak.All but the dead case were followed up for 2～60 months (mean 38.6 months),there were no recurrence in total removal patients and 2 recurrences in subtotal removal cases within 40 months,56 months respectively after operation. Conclusions The transoral-nosal-sphenoidal approach for removal of large pituiaary adenomas is a safe and effective way and has a good outcome.The key factor determining whether the tumors can be total removed is the microsurgical techique and the indications.

关 键 词：口鼻蝶窦 显微切除术 垂体腺瘤 手术指征 肿瘤 

分 类 号：R736.4[医药卫生—肿瘤]