经单鼻孔蝶窦入路切除垂体大腺瘤  

Microsurgery via the Single Side of Norstril-sphenoidal Approach to Remove Pituitary Macroadenoma

作　　者：周开宇[1,2] 王广涛[1,2] 金杭煌[1,2] 杨伯捷[3] 

机构地区：[1]浙江省台州市立医院神经外科 [2]复旦大学附属华山医院台州分院,318000 [3]复旦大学附属华山医院神经外科,200040

出　　处：《中国临床神经科学》2009年第5期499-504,共6页Chinese Journal of Clinical Neurosciences

基　　金：浙江省医药卫生科技计划A类资助项目(编号:2009A226);浙江省台州市科技局资助项目(编号:051KY48);浙江省台州学院资助项目(编号:08ND33);浙江省台州市椒江区科技局资助项目(编号:31067)

摘　　要：目的：探讨经单鼻孔蝶窦入路手术治疗垂体大腺瘤的方法与疗效。方法：回顾性分析经单鼻孔蝶窦入路显微手术治疗34例垂体大腺瘤的临床资料，总结并分析肿瘤切除程度、术后视野恢复情况和手术前后血清激素水平变化。结果：术后行MRI、视野复查显示，近全切除23／34例（67．65％），术后视野恢复好转率91．30％；次全切除5／34例（14．71％），术后视野恢复好转率80．00％;大部分切除4，34例（11．76％），术后视野恢复好转率75．00％；部分切除2／34例（5．88％），术后视野恢复好转率50．00％；术后总体视野恢复好转率85．29％；无手术死亡病例。手术前血泌乳素、生长激素水平下降与手术后比较差异有统计学意义（前者仁2．57，P〈0．05；后者仁3．01，P〈0．05）。随访28例，随访4-73个月，平均27个月。15，28例（53．57％）治愈，10／28例（35．71％）控制，3/28例（10．71％）复发。9例接受立体定向放射外科治疗。结论：经蝶窦入路切除垂体大腺瘤是安全有效的手术方法，能改善大部分患者的视野缺损、能明显降低功能性腺瘤患者的激素水平。Aim： To investigate the methods and effects to remove pituitary macroadenoma. Methods： Records of 34 pituitary macroadenoma cases received microneurosurgery via the single side of norstrilsphenoidal approach were retrospectively analyzed. The extent of resection and the visual field defect recovery, changes of serumal hormone level before and after operation were summarized. Results： No surgery-related deaths were observed. Postoperative MRI and the visual field defect examination revealed that the gross total resection were achieved in 23 cases, the improvement rate of visual field effect recovery after operation was 91.30%. The subtotal resection were achieved in 5 cases, the improvement rate of visual field effect recovery after operation was 80.00%. The mostly partial resection was achieved in 4 cases, the improvement rate of visual field effect recovery after operation was 75.00%. The partial resection was achieved in 2 cases, the improvement rate of visual field effect recovery after operation was 50.00%. The total improvement rate of visual field effect recovery after operation was 85.29%. The differences of statistical significance were found in serumal PRL or GH hormone level before and after operation（P〈0.05）. Follow-up observations were carried out for 4 - 73 months （mean, 27months） in 28 cases. 9 cases were received stereotactic radiosurgery. 15 cases were cured. 10 cases were controlled. 3 cases were recurrence. Conclusion： Via the single side of norstril-sphenoidal approach microsurgery is a safe and effective operation for the treatment of pituitary macroadenoma, which can improve the visual field effect of the majority of cases and significantly decrease the serum hormone levels of functional adenoma.

关 键 词：垂体大腺瘤 经蝶入路 显微外科 

分 类 号：R736.4[医药卫生—肿瘤]