非分泌性垂体腺瘤的显微外科手术策略  

Microsurgical strategy for nonsecreting pituitary adenomas

作　　者：骆纯[1] 卢亦成[1] 孙克华[1] 丁学华[1] 胡国汉[1] 楼美清[1] 陈菊祥[1] 姚志强[1] 

机构地区：[1]上海市神经外科研究所,上海长征医院神经外科,上海200003

出　　处：《中华神经医学杂志》2005年第8期794-796,共3页Chinese Journal of Neuromedicine

基　　金：上海市科委重点项目(044119658);上海市卫生局医苑新星培养计划(2002049)

摘　　要：目的探讨非分泌性垂体腺瘤治疗的显微外科手术策略。方法回顾分析经手术证实的236例非分泌性垂体腺瘤的临床资料,采取四种显微手术策略:经蝶手术202例(85.59%),开颅手术15例(6.36%),经蝶+开颅手术11例(4.66%),分次经蝶手术8例(3.39%)。结果显微手术全切除171例(72.46%),次全切除65例(27.64%)。无围手术期严重并发症,视力视野改进占88.02%。甲状腺功能恢复正常占38.98%,血清催乳素水平恢复正常占70.63%。免疫组化研究提示促性腺激素细胞腺瘤占52.54%,裸细胞腺瘤占25.00%,大嗜酸粒细胞腺瘤占14.41%,静态促肾上腺皮质激素腺瘤占8.05%。结论对于非分泌性垂体腺瘤,根据个性化的原则,采取不同的显微外科手术策略,可以取得满意的疗效。Objective To investigate the microsurgical strategies for nonsecreting pituitary adenomas. Methods The clinical data of 236 cases with nonsecreting pituitary adenomas were retrospectively analyzed. They were treated with four kinds of different microsurgical strategies： the transsphenoidal approach in 202 cases （85.59%）, transcranial surgery in 15 cases （6.36%）, both transsphenoidal and transcranial surgery in 11 cases （4.66%）, intentionally staged transsphenoidal surgery in 8 cases （3.39%）. Results Total removal was achieved in 171 cases （72.46%）, and subtotal removal in 65 cases （27.64%）. There were no severe perioperative complications. Visual disturbances were improved in 88.02% of patients. Thyroid function was recovered in 38.98% of patients with preoperative hypothyroidism. In the cases involving hyperprolactinemia, serum prolactin （PRL） levels came to normal in 70.63%. Histological and immunohistochemical studies demonstrated gonadotroph adenomas in 52.54%, null-cell adenomas in 25.00%, oncocytomas in 14,41%, and silent adrenocorticotropic hormone （ACTH） adenomas in 8,05%. Conclusion As for the nonsecreting pituitary adenoma, different surgical strategies should be applied according to the individuality of each case, and then excellent results could be achieved.

关 键 词：非分泌性 垂体腺瘤 显微外科手术 

分 类 号：R736.4[医药卫生—肿瘤]