经鼻蝶窦入路切除海绵窦侵袭性垂体腺瘤的临床研究  

Resection of pituitary adenomas invading cavernous sinus through transsphenoidal approach

作　　者：黄忻涛[1] 郝解贺[1] 马宁[1] 万大海[1] 刘跃亭[1] 薛乃照[1] 孙之洞[1] 

机构地区：[1]山西医科大学第一医院神经外科,太原030001

出　　处：《中华神经外科杂志》2014年第6期564-567,共4页Chinese Journal of Neurosurgery

基　　金：山西省科技攻关项目（2007031092-4）

摘　　要：目的探讨侵袭海绵窦垂体腺瘤的特点、经鼻蝶窦入路适应证及手术治疗体会。方法回顾性分析采用经鼻蝶窦入路切除侵袭海绵窦垂体腺瘤的临床资料，分析肿瘤切除程度、激素水平的变化以及出现的并发症。结果23例患者中，肿瘤全切除7例，次全切除12例，部分切除4例。病理检查无功能腺瘤12例，催乳素腺瘤10例，生长激素腺瘤1例。术后催乳素4例降至正常范围，4例下降≥80％，2例下降〈80％；1例生长激素下降〉50％。手术并发症包括垂体功能低下3例，脑脊液鼻漏1例，视力恶化1例，短暂脑神经麻痹2例，一过性尿崩5例，电解质紊乱4例。18例得到了随访，时间3个月～2年，5例复发。结论采用经鼻蝶窦入路切除侵袭海绵窦垂体腺瘤，肿瘤显露及切除满意，手术并发症少，患者恢复快。Objective To explore the characteristics, surgical indications, methods and outcomes of the resection of invasive pituitary adenomas through transsphenoidal approach. Methods The clinical data of patients with pituitary adenomas invading cavernous sinus underwent surgery through transsphenoidal approach were analyzed retrospectively. The extent of tumor removal, the change of hormone levels and the postoperative complications were analyzed. Results In 23 cases, total tumor removal was achieved in 7 cases, subtotal in 12, and partial in 4. There were 12 cases of non - functioning adenomas, 10 prolactinomas and 1 growth hormone adenoma. The postoperative PRL levels were decreased to normal in 4 cases, ≥80% in 4, 〈 80% in 2. The postoperative GH level was decreased to 〉50% in 1 case. The postoperative complications included 3 cases of hypopituitarism, 1 cerebrospinal fluid fistulae, 1 deterioration of vision, 2 transient cranial nerve palsy, 5 transient diabetes insipidus and 4 electrolyte unbalance. 18 cases had been followed - up from 3 months to 2 years, 5 cases of recurrence. Conclusions The pituitary adenomas invading cavernous sinus could be revealed and removed satisfactorily with fewer surgical complications through the transsphenoidal approach.

关 键 词：经蝶窦手术 垂体腺瘤 侵袭性 海绵窦 

分 类 号：R736.4[医药卫生—肿瘤]