经翼点入路显微手术切除鞍区肿瘤46例  

Microsurgical removal of sellar region tumors via pterional approach: a report of 46 cases

作　　者：王瑞奇[1] 仝海波[2] 王永红[2] 郝解贺[2] 孙之洞[2] 范益民[2] 刘跃亭[2] 

机构地区：[1]太原市中心医院神经外科,太原030009 [2]山西医科大学第一临床医学院神经外科

出　　处：《山西医科大学学报》2007年第9期831-833,共3页Journal of Shanxi Medical University

摘　　要：目的总结翼点入路在鞍区肿瘤显微手术的临床应用经验,为临床提供参考。方法回顾性分析近年来我科经翼点入路对鞍区肿瘤进行显微外科手术的病例。讨论鞍区肿瘤经翼点入路显微手术的适应证、并发症,分析影响选择经翼点入路显微外科手术的相关因素。结果46例患者中37例镜下全切并由影像学证实,全切率80.4%,2例近全切除,6例行大部切除,1例行部分切除。有2例额纹消失;尿崩及电解质紊乱5例;死亡1例。平均随访10个月,肿瘤未见有复发及生长扩大迹象。结论翼点入路为鞍区肿瘤的手术操作创造了较大的空间,能满足鞍区不同部位病变的暴露,以最小的脑损伤和尽可能少的手术并发症,完成向鞍上鞍旁生长的垂体瘤、颅咽管瘤、蝶骨嵴脑膜瘤、鞍结节脑膜瘤的切除,为提高患者的生存质量和减少肿瘤的复发创造必要条件。Objective To summarize the clinical experience of the microsurgical operation in sellar region tumors via the pterional approach. Methods The clinical data were reviewed in forty-six patients hospitalized in First Clinical Medical College of Shanxi Medical University from December 2002 to September 2005 . Clinical features, CT or MRI characteristics of the patients were stud- led. The operative results and complications were discussed also in microsurgical techniques, and the factors affecting the choice of the pterional approach were analyzed. Results Of 46 cases, 37 obtained good results, and the total resection rate of sellar region tumors was 80.4 %. One patient died after the surgery. Two patients were facial paralysis. Five patients had diabetes insipidus and electrolyte disorder. There was no recurrence after follow up for 10 months. Conclusion The pterional approach for removing sellar region tumors has the advantages of short working distance, minimal injury to the neural structures and sufficient exposure of the tumor. It is a better opration for successful total removal of the giant or large pituitary adenoma which growing toward the suprasellar and parasellar extension, the craniopharyngioma, crista sphenoidalis meningioma and the tuberculum sellae meningioma, and could improve the patients＇ life quality and decrease the recurrence of the tumor.

关 键 词：显微外科手术 翼点入路 鞍区肿瘤 

分 类 号：R616.2[医药卫生—外科学]