开颅手术治疗巨大垂体腺瘤的临床分析  

Treatment for giant pituitary adenomas through transcranial approach in a series of 112 consecutive patients

作　　者：张艳阳[1] 许百男[1] 姜金利[1] 冯世宇[1] 卜博[1] 周涛[1] 余新光[1] 周定标[1] 

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《中华外科杂志》2015年第3期197-201,共5页Chinese Journal of Surgery

摘　　要：目的 探讨巨大垂体腺瘤的临床特点、开颅手术方法及治疗效果.方法 回顾性分析2009年1月至2014年2月解放军总医院神经外科开颅手术治疗的112例巨大垂体腺瘤患者临床资料.男性58例,女性54例;年龄16 ～72岁,平均44.3岁.无功能性垂体腺瘤91例,功能性垂体腺瘤21例.术前MRI显示肿瘤最大径为4.0～7.2 cm,平均4.8cm.手术采用单侧额下外侧入路16例,翼点入路41例,前纵裂入路34例,经胼胝体穹隆间入路6例,经皮层脑室入路5例,联合入路6例,其他入路4例.术后随访头颅MRI及内分泌指标,根据情况选择二期经蝶手术、药物治疗及放射治疗.结果 肿瘤全切除57例（50.9％）,次全切除26例（23.2％）,大部切除29例（25.9％）.术后死亡3例（2.7％）,术后严重并发症38例（33.9％）.94例患者获得随访,随访率83.9％.随访时间3～64个月,平均19.5个月.术后视力好转或者无改变98例（87.5％）.功能性垂体腺瘤内分泌缓解19例（90.5％）.82例（87.2％）术后能参加日常工作和学习,肿瘤复发8例.结论 根据术前影像学及临床表现,个体化选择合适的入路,是开颅手术成功切除巨大垂体腺瘤的关键.术后行二期经蝶手术或药物及放射治疗,可以控制残留肿瘤.Objective To investigate the clinical features,surgical transcranial approaches and outcomes of giant pituitary adenomas.Methods A series of 112 consecutive cases of giant pituitary adenomas underwent microsurgery through transcranial approaches at People＇s Liberation Army General Hospital were retrospectively analyzed.Of the 112 patients,58 were male and 54 were female,with age ranging from 3 to 72 years（mean age 44.3 years）.There were 91 non-functioning adenomas and 21 hormonesecreting adenomas.The maximum tumor diameter varied from 4.0 to 7.2 cm,with mean diameter of 4.8 cm.Unilateral subfrontal approach was chosen in 16 cases,pterional approach in 41 cases,anterior interhemispheric approach in 34 cases,transcallosal-interforniceal approach in 6 cases,transcorticaltransventricular approach in 5 cases,combined approach in 6 cases and other approaches in 4 cases.Postoperative MRI and endocrine function were re-examined routinely to evaluate the therapeutic efficacy.Staged operation through transsphenoidal approach or adjuvant treatments including medical and radiation therapies were administered in patients with hormone-secreting adenomas when hormonal excess persisted after surgery and in patients with non-functioning adenomas who had postoperative MRI evidence of residual tumor.Results Total removal of the lesion was achieved in 57 cases （50.9%）,26 patients （23.2%） underwent subtotal resection,and 29 patients （25.9%） underwent partial removal.Postoperative mortality occurred in 3 patients （2.7%）.Major surgical morbidity occurred in 38 patients （33.9%）.Vision was preserved or improved in 98 patients （87.5%）.The postsurgical follow-up period varied from 3 to 64 months （mean 19.5 months）.Nineteen of the 21 patients with hormone-secreting adenomas were considered to be in hormonal remission,and 87.2% of the cases were capable of normal work and life and 8 patients suffered recurrence during the followed-up period.Conclusions Selection of appropriate transcranial approaches is the

关 键 词：垂体肿瘤 腺瘤 显微外科手术 

分 类 号：R736.4[医药卫生—肿瘤]