经翼点入路显微手术切除巨大垂体腺瘤的技术方法与疗效分析  

Application of microsurgical resection to giant pituitary adenoma via pterional approach and its efficacy

作　　者：吴景文[1] 章翔[2] 曲超法[1] 李建[1] 邱勇[1] 钱春生[1] 

机构地区：[1]解放军第211医院神经外科,黑龙江哈尔滨150080 [2]第四军医大学西京医院神经外科,陕西西安710032

出　　处：《中国耳鼻咽喉颅底外科杂志》2014年第6期495-497,501,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的探讨经翼点入路显微手术切除巨大型垂体腺瘤的技术方法。方法回顾性分析收治的巨大型垂体腺瘤患者52例,肿瘤直径均>3 cm,向鞍上及鞍周发展。对患者均采用显微镜下经翼点硬膜内开颅切除肿瘤,随访观察其疗效。结果肿瘤全切除45例,次全切除7例。术后并发鞍区积气10例,多饮、多尿8例,脑膜炎2例,瘤床少量出血1例,上述并发症均经治疗后痊愈。本组患者视力术后均有不同程度恢复,20例垂体激素增高者术后有16例降至正常范围,无死亡病例。术后均随访6个月至3年,肿瘤残余与复发患者8例,均给予伽马刀治疗;术后6个月的垂体泌乳素水平仍高于正常者4例,予溴隐亭治疗后恢复正常。结论对巨大型突入鞍上和鞍旁的垂体腺瘤,可采用经翼点入路显微手术方式切除,其疗效满意;术后应定期随访观察。Objective To introduce the technique of microsurgical resection of giant pituitary adenoma via pterional approach and to evaluate its surgical effect. Methods Clinical data of 52 cases with giant pituitary adenomas （tumor diameter 〉 3 cm, infiltrating to supra and parasella regions ） was analyzed retrospectively. The tumors were microsurgically resected via pterional intradural approach in all patients. Results Total tumor resection was achieved in 45 cases, and subtotal resection in 7. Postoperative complications included sellar pneumatosis （ n = 10）, polydipsia and polyuria（n =8）, meningitis（n =2）, and tumor bed hemorrhage（n = 1）. And all the complications were cured after treatment. The patients had recovery of visual acuity in different degrees after operation. Elevated pituitary hormone decreased to normal range in 16 of 20 cases. No death occurred. Follow-up periods ranged from 6 months to 3 years. Remnant and recurrence of tumor occurred in 8 cases and received GammaKnife treatment. Pituitary hormone level was still higher than normal after 6 months of operation in 4 cases, and returned to normal after Bromocriptine treatment. Conclusions With satisfactory therapeutic effect, giant pituitary adenomas infiltrating to suprasellar and parasellar regions can be mierosurgically excised via pterional approach. Postoperative follow-up is necessary.

关 键 词：垂体腺瘤 经翼点入路 显微手术 随访 

分 类 号：R765.13[医药卫生—耳鼻咽喉科]