垂体瘤术中视路结构和垂体柄的保护及预后  

Visual pathway and pituitary stalk protection in pituitary tumor surgery and the clinical outcome

作　　者：巩守平[1] 吕健[1] 宋千[1] 杨庆余[1] 

机构地区：[1]西安交通大学医学院第二附属医院神经外科,陕西西安710004

出　　处：《南方医科大学学报》2009年第2期305-306,共2页Journal of Southern Medical University

摘　　要：目的探讨垂体瘤显微外科解剖和肿瘤的生长方式与视路恢复的关系,以及术中对垂体柄及视路的保护。方法回顾分析1997～2007年间113例垂体瘤手术,肿瘤大小1.9～6.8cm,其中102例患者有视力障碍,106例有垂体功能障碍。手术均采用经额或经翼点入路。结果86例肿瘤全切,21例次全切,5例大部切除。术后视力好转133只眼(77.8%),无变化29只眼(17%),下降9只眼(5.2%)。死亡2例(分别死于下丘脑功能障碍和多脏器功能衰竭)。结论垂体瘤与视路结构之间的蛛网膜屏障是手术保护视路结构的关键,严格地在其间分离使全切肿瘤成为可能;术前对垂体柄的定位及术中辨别垂体柄是保护垂体柄完整性的关键。Objective To investigate the association ofmicrosurgical anatomy and growth of pituitary tumors with the recovery of visual pathway, and describe the intraoperative protection of the pituitary stalk and visual pathway. Methods A total of 113 patients undergoing pituitary tumor surgery were retrospectively analyzed, including 102 with visual disorder and 106 with pituitary dysfunction with the tumor size ranging from 1.9 to.6.8 cm. All the operations were performed via a transpterygoid approach or transfrontal approach. Results Radical resection of the tumors was performed in 86 cases, subtotal resection in 21 cases, and partial resection in 5 cases. After operation, 133 eyes showed vision improvement （77.8%）, 29 showed no visien changes （17%） and 9 had deteriorated vision. Two patients died due to hypothalamic disorder and multiple organ failure. Conclusion The arachnoid barrier between the pituitary tumor and visual pathway is an important structure for visual pathway protection during operation. Total separation of the tumor from the visual pathway allows total removal of the tumor. The preoperative localization and intraoperative identification of the pituitary stalk are critical for pituitary stalk protection.

关 键 词：垂体肿瘤 显微手术 视神经 垂体柄 

分 类 号：R736.4[医药卫生—肿瘤]