经蝶显微手术治疗垂体腺瘤3375例  

Treatment of 3 375 Patients with Pituitary Adenomas by microsurgery through Transsphenoidal Approach

作　　者：李士其[1] 王镛斐[1] 赵曜[1] 寿雪飞[1] 贾丕枫[1] 

机构地区：[1]复旦大学附属华山医院神经外科研究所,上海200040

出　　处：《中国临床神经外科杂志》2005年第6期403-406,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的系统、全面地介绍经蝶显微手术治疗垂体腺瘤的临床综合疗效,并对手术技巧、新技术的应用以及术后随访进行深入探讨。方法回顾性分析华山医院1981年12月至2002年4月行经蝶显微手术治疗的垂体腺瘤3375例,对其临床表现、影像学及内分泌资料、肿瘤病理、肿瘤切除率、术后并发症、术后随访进行总结分析。结果近4年来,HardyⅠ级的肿瘤全切率已达97.0%,Ⅱ级95.2%,Ⅲ级90.5%,Ⅳ级为47.4%。;肿瘤全切及次全切除率已由1987年前的87.6%提高至2000至2001年的96.9%。结论随着显微操作日益娴熟及新技术的应用,经蝶入路手术指征不断扩大,我们认为90%以上的垂体肿瘤适合经蝶窦入路。90%以上肿瘤可以做到显微镜下全切除。经鼻-垂直板-蝶窦入路将是该入路的主导方式。全切除者术后不必行常规放疗。Objective To evaluate the therapeutic effect of transsphenoidal microsurgery on pituitary adenomas and to explore the surgical skill and new technology applied to transsphenoidal microsurgery for pituitary adenomas. Method The clinical manifestations, image characteristics, endocrine finding, pathological type, removal percentage, postoperative complications and follow-up data of 3375 cases with pituitary ademomas undergoing the transsphenoidal microsurgery from December, 1981 to April, 2002 were analysed retrospectively. Results In the recent 4 years, the rate of total removal of the tumors were 97.0% in the patients with Hardy Ⅰ adenomas, 95.2% in the patients with Hardy Ⅱ, 90.4% in the patients with Hardy Ⅲ, and 47.4% in the patients with Hardy Ⅳ. The rate of total and subtotal removal went up from 87.6% before the year 1987 to 96.9% in the year 2001. Conclusions The indication of transsphenoidal microsurgery for pituitary adenomas is increasingly extended, and more than 90% of the pituitary adenomas can be treated by mierosurgery through transsphenoidal approach due to the improved microsurgical skill and application of new technique. The rate of total removal of adenomas through the transsphenoidal microsurgery is over 90%. The transnasal-perpendicular platesphenoid sinus approach should be the dominant mode of transsphenoidal microsurgery. The postoperative routine radiotherapy is unnecessary for the patients receiving total removal of the adenomas.

关 键 词：垂体腺瘤 显微手术 经蝶入路 

分 类 号：R736.4[医药卫生—肿瘤] R651.13[医药卫生—临床医学]