垂体腺瘤经蝶术后早期继发急性视功能减退的原因及其防治(附11例分析)  

Causes and treatment of early acute visual deterioration after pituitary adenoma resection via transsphenoidal approach:11 cases report

作　　者：杨众[1] 任祖渊[1] 苏长保[1] 王任直[1] 杨义[1] 马文斌[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院神经外科,北京100730

出　　处：《中国微侵袭神经外科杂志》2008年第3期104-106,共3页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：首都医学发展基金重点支持课题(2003-2015)

摘　　要：目的探讨经蝶切除垂体腺瘤术后早期继发急性视功能恶化的原因,并提出防治措施。方法分析经蝶手术切除垂体腺瘤术后11例早期继发急性视功能恶化病例的临床资料。本组均为1999年以前的病例。病人均在术后3d内继发急性视功能恶化,根据视功能恶化的原因,再次行经颅手术5例,经蝶手术1例,脑室外引流1例,保守治疗4例。结果治疗后视功能恢复良好6例,3例视神经损伤者、1例鞍内填塞过紧者及1例鞍内血肿者恢复欠佳。结论术后早期继发急性视功能恶化的原因是在视神经和视交叉受到垂体腺瘤压迫而导致血运变差的基础上,与继发鞍内血肿、手术时直接损伤、急性视交叉缺血、鞍内填塞过紧等因素有关。该并发症可以避免。一旦出现,应尽早明确病因,予以相应处理。Objective To explore the causes of early acute visual deterioration after pituitary adenoma resection via transsphenoidal approach. Methods Clinical data of 11 patients suffering, before 1999, early postoperative acute visual deterioration after pituitary adenoma resection by transsphenoidal approach were analyzed retrospectively, The acute early postoperative visual deterioration occurred within 3 days after the transsphenoidal surgery in all the patients. Five patients underwent transcranial operation, one accepted transsphenoidal operation and one external ventricular drainage, The other 4 cases were treated conservatively. Results After all these treatments, good recovery achieved in 6 cases, not so well in 3 with optic nerve injury, 1 with intrasellar over-packing, and 1 with intrasellar hematoma. Conclusion Severe complication, visual deterioration, of transsphenoidal surgery may be caused by hematoma, direct injury during the operation,and acute ischemia of the optic chiasma and overtight packing in the sella turcica, etc,and is often associated with optic nerve ischemia caused by oncothlipsis, thus could be prevented. Once occur, the causes should be found out as soon as possible and followed by corresponding treatment.

关 键 词：垂体肿瘤 经蝶手术 手术后并发症 视觉障碍 

分 类 号：R736.4[医药卫生—肿瘤]