并发梗阻性脑积水的卒中型垂体巨大腺瘤的手术治疗策略  

Surgery for giant pituitary adenomas apoplexy complicated with obstructive hydrocephalus

作　　者：肖德勇[1] 赵琳[1] 黄银兴[1] 林昆哲 王守森[1] 

机构地区：[1]南京军区福州总医院神经外科,福州350025

出　　处：《中华神经医学杂志》2016年第12期1246-1250,共5页Chinese Journal of Neuromedicine

基　　金：（1）基金项目：南京军区医学科技创新重点课题（112034）（2）基金项目：南京军区福州总医院创新团队基金（2014CXTD07）

摘　　要：目的探讨并发梗阻性脑积水的卒中型垂体巨大腺瘤的手术治疗策略。方法南京军区福州总医院神经外科自2010年1月至2015年3月收治并发梗阻性脑积水的卒中型垂体巨大腺瘤患者23例，本文回顾性分析患者的临床资料和疗效。结果23例患者中经鼻蝶入路显微切除术22例．经翼点入路开颅切除术1例。术中见23例垂体腺瘤均呈囊实性，其中7例有淡黄色或透明囊液，16例有酱油色或淡暗红色囊液；肿瘤实质部分质地均较软；肿瘤近全切除2例（8．7％），次全切除16例（69．6％），大部分切除5例（21．7％）。23例患者均获随访4～38个月，1例患者因肿瘤残留较多于术后4个月时接受了第2次经鼻蝶入路显微手术，5例患者术后接受放射治疗，余患者未见肿瘤继续生长或复发。术后脑积水缓解率为100％，头痛改善率为81．8％，视力改善率为60．9％，无长期脑脊液漏和顽固性尿崩等并发症发生。结论并发梗阻性脑积水的卒中型垂体巨大腺瘤的瘤体多较软。经鼻蝶入路显微手术是安全有效的首选治疗方法，可缓解脑积水，明显改善临床症状。Objective To evaluate the surgical strategy for giant pituitary adenomas apoplexy complicated with obstructive hydrocephalus. Methods Twenty-three patients with giant apoplectic pituitary adenomas associated with obstructive hydrocephalus, admitted to our hospital from January 2010 to March 2015, were chosen; their clinical and surgery data were retrospectively summarized. Results Transsphenoidal microsurgery was conducted in 22 patients and craniotomy in one. All tumors showed cystic degeneration and soft texture. Seven patients had faint yellow or hyaline cyst fluid and 16 had soybean sauce or dark red cyst fluid. Near-total tumor resection was achieved in 2 patients （8.7%）, subtotal resection in 16 （69.6%）, and partial resection in 5 （21.7%）. Twenty-three patients were followed up for 4-38 months, one patient accepted repeated operation for residual tumors, 5 had postoperative adjuvant radiation therapy, and no other patients showed re-growth or recurrence. Postoperatively, there was no long-term cerebrospinal fluid leakage and diabetes insipidus, with hydrocephalus disappeared in 100%, visual improved in 60.9%, and headache relieved in 81.8%. Conclusions Pituitary adenoma presented with apoplexy and concurrent obstructive hydrocephalus is often soft. Transsphenoidal microsurgery is the preferred safe and effective method which can relieve hydrocephalus and achieve improved clinical symptoms.

关 键 词：垂体腺瘤 垂体卒中 脑积水 显微外科手术 经鼻蝶入路 

分 类 号：R736.4[医药卫生—肿瘤]