经蝶手术切除向鞍上生长垂体腺瘤的术前评估与疗效分析  

Preoperative evaluation and efficacy analysis of transsphenoidal microsurgery removal of pituitary adenomas with suprasellar extension

作　　者：齐春晓[1] 王宁[1] 郭芳[1] 李军[1] 李莹[1] 韩韶 

机构地区：[1]哈尔滨医科大学附属第一医院神经外科,150001

出　　处：《中国微侵袭神经外科杂志》2014年第1期25-27,共3页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨经鼻蝶窦显微镜手术切除向鞍上生长垂体腺瘤的术前难度评估及手术效果。方法回顾性分析62例经鼻蝶窦显微镜手术治疗的向鞍上生长的垂体腺瘤病人的临床资料,肿瘤呈哑铃型生长15例,非哑铃型生长47例。总结术前MRI结果、手术切除程度、术后并发症及其处理措施。结果显微镜下肿瘤全切除37例,近全切除16例,部分切除9例。术后视力视野障碍好转30例,一过性视力减退4例;头痛症状消失或明显减轻21例;余病人无明显变化。发生术中脑脊液漏12例,经保守治疗后治愈;一过性尿崩症16例;电解质紊乱17例;无手术及并发症相关的死亡病例。结论经鼻蝶窦显微镜手术对切除向鞍上生长的垂体腺瘤仍是有效的治疗方式,详细的术前评估和术者的丰富经验有利于减少手术并发症的发生。Objective To explore the preoperative evaluation and efficacy analysis of transsphenoidal microsurgery removal for pituitary adenomas with suprasellar extension. Methods Clinical data of 62 patients of pituitary adenomas with suprasellar extension undergoing transsphenoidal microsurgery were analyzed retrospectively. The tumor grew in dumbbell shape were in 15 patients and in non-dumbbell shape in 47. The cranial MRI findings, surgical treatment results, postoperative complications and therapeutic means of complications were summarized. Results Total tumor resection under microscope was achieved in 37 patients, subtotal resection in 16 and partial resection in 9. The visual disturbance and visual field defects were improved postoperation in 30 patients, and transient deterioration of visual acuity appeared in 4. The symptom of headache disappeared or obviously relieved in 21 patients after the surgery, and was not obviously changed in other patients. Intraoperative cerebrospinal fluid leak appeared in 12 patients and was cured by conservative treatment. Transient diabetes insipidus occurred in 16 patients and electrolyte disorder in 17. There was no death caused by surgery procedures or complications. Conclusion Transsphenoidal approach microsurgery is an effective way for resecting pituitary adenomas with suprasellar extension, careful evaluation before surgery and rich experience of the neurosurgeon can decrease the surgical complications.

关 键 词：垂体肿瘤 手术入路 经蝶窦 手术指征 

分 类 号：R736.4[医药卫生—肿瘤]