巨大型垂体腺瘤手术中对垂体柄的保护及其意义  

Preservation of pituitary stalk in the microsurgery of giant pituitary adenoma and its significance

作　　者：贾桂军[1] 万伟庆[1] 倪明[1] 贾旺[1] 周大彪[1] 张冰克[1] 关树森[1] 张俊廷[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050

出　　处：《中华医学杂志》2008年第23期1627-1629,共3页National Medical Journal of China

摘　　要：目的探讨巨大型垂体腺瘤在手术中垂体柄的保护及其临床意义。方法巨大型垂体腺瘤45例，男23例，女22例，平均年龄40．8岁。其中12例为侵袭性垂体腺瘤，全部病例均根据影像学资料施行适宜的开颅肿瘤切除术，记录术中垂体柄与肿瘤的解剖学关系，总结垂体柄保护的方法及注意事项。结果45例中肿瘤全切除25例，近全切除12例，大部切除8例。33例非侵袭性垂体腺瘤中，术中均见到垂体柄且形态良好；侵袭性垂体腺瘤有5例未见到垂体柄，可见到垂体柄的患者中部分（4例）形态不完整。12例侵袭性垂体腺瘤中，2例术后出现残余肿瘤出血，二次手术后有1例患者死于术后下丘脑损伤。结论巨大垂体腺瘤瘤体与垂体柄的毗邻关系多样：垂体柄位于肿瘤侧方（左或右）、后上方者最为常见，而位于肿瘤前方者少见；侵袭性垂体腺瘤中，肿瘤与垂体柄的关系不甚明确。但术中辨清并保护好垂体柄将直接影响手术疗效及患者预后。Objective To investigate and elucidate how to preserve the pituitary stalk in the microsurgery of giant pituitary adenoma （GPA） and its clinical significance. Methods 45 GPA patients, 23 males and 22 female; aged 40.8, including 12 cases of invasive pituitary adenoma （IPA） underwent craniotomy based on the respective preoperative neuroradiological imaging characteristics. The anatomical relationship between the pituitary stalk and tumor was recorded. The methods to protect the pituitary stalk were summarized. Results Total tumor excision was achieved in 25 patients （55. 5% ）, near-total resection was done in 12 （26. 7% ）, and subtotal resection in 8 （ 17.8% ）. During the surgical proceeding, the pituitary stalk was distinguished from the tumor and preserved well in all 33 cases with non-invasive giant pituitary adenoma. On the contrary, in the 12 cases of invasive giant pituitary adenoma （IPA） the pituitary stalk was visualized in only 7 eases. In the patients with visualized pituitary stalks 4 pituitary stalks were not identified very well. In most eases （91%）the pituitary stalks were located laterally （on the left or right side） or supero-posterior to the tumor, only a few were located anteriorly. In all 12 IPA patients 2 eases of postoperative hemorrhage occurred associated with remnant tumor and immediate hematoma evacuation was performed, however, one patient died due to hypothalamus injury. Conclusion Pituitary stalk has various anatomical relationships to the entity of GPA; most are located lateral or supero-pesterior to the tumor. However, the relationship between the stalk and tumor is not clear in IPA. Identifying and preserving the pituitary stalk well during surgical manipulation will be beneficial to get an excellent outcome.

关 键 词：垂体肿瘤 显微外科手术 临床分析 治疗方法 

分 类 号：R686[医药卫生—骨科学]