经单鼻孔蝶窦入路显微手术切除垂体腺瘤  

Resection of pituitary adenoma by unilateral endonasal transsphenoidal approach microsurgery

作　　者：武文元[1] 武强[1] 张占普[1] 王涛[1] 马庆海[1] 李明洙[1] 窦长武[1] 高乃康[1] 

机构地区：[1]内蒙古医学院附属医院神经外科,呼和浩特010050

出　　处：《中华神经医学杂志》2007年第5期485-487,共3页Chinese Journal of Neuromedicine

摘　　要：目的总结经单鼻孔蝶窦入路显微手术切除垂体腺瘤的方法及经验。方法2002年1月～2006年10月我院采用经单鼻孔蝶窦入路行垂体腺瘤切除术32例,其中微腺瘤2例,小腺瘤9例,中腺瘤16例,大腺瘤5例。结果全切除30例,次全切除2例。病理检查类型为泌乳素腺瘤27例,生长激素腺瘤3例,混合性腺瘤2例。无手术死亡病例。术后出现一过性尿崩6例,脑脊液鼻漏2例,经治疗后好转。平均随访4个月,临床症状术后短期内均有改善,激素水平术前升高的均有下降。结论经单鼻孔蝶窦入路是治疗垂体腺瘤的一种有效可靠的手术方法,具有创伤小、手术时间短、并发症少、术后康复时间短、手术死亡率低、垂体功能保存率高等优点,可作为绝大多数垂体腺瘤患者的首选治疗方法。Objective To summarize the experience in treating pituitary adenoma by microsurgery through unilateral endonasal transsphenoidal approach. Methods From January 2002 to October 2006, microsurgical resection through unilateral endonasal transsphenoidal approach was performed in our hospital on 32 patients with pituitary adenomas including microadenomas （diameter〈10 mm） in 2, small adenomas （10-20 mm） in 9, middle adenomas （20-30 mm） in 16, macroadenomas （〉30 mm） in 5. Results Of 32 patients with pituitary adenoma, 30 received total resection of the tumors and 2 subtotal. Pathological examination revealed prolactinomas （PRL）-secreting adenomas in 27, growth hormone （GH）-secreting adenomas in 3, and PRL＋GH-secreting adenomas in 2, all were improved by treatment. No patients died of operation. There was temporal diabetes insipidus in 6 patients and cerebrospinal fluid rhinorrhea in 2. The following-up for mean 4 months showed that the patients were improved in the clinical symptoms, and the hormone level decreased in 32, and the operative effect was good. Conclusion The microsurgery through unilateral endonasal transsphenoidal approach for the pituitary adenomas had advantages such as minimal invasion, short operative time, few complications, good preservation of pituitary function and fast rehabilitation as well as very low mortality. The unilateral endonasal transsphenoidal microsurgery should be first selected for the patients with pituitary adenomas.

关 键 词：垂体腺瘤 经单鼻孔入路 经蝶窦入路 显微外科手术 

分 类 号：R736.4[医药卫生—肿瘤]