侵袭海绵窦的大型及巨大型垂体腺瘤的临床治疗策略分析(附109例报道)  

Clinical treatment strategy of large and giant pituitary adenomas invading cavernous sinus:an analysis of 109 cases

作　　者：肖凯[1] 张丰启 陈奕宏 吴长武 秦超颖 苏君[1] 刘定阳[1] 彭刚[1] 袁健[1] 袁贤瑞[1] 刘庆[1] Xiao Kai;Zhang Fengqi;Chen Yihong;Wu Changwu;Qin Chaoying;Su Jun;Liu Dingyang;Peng Gang;Yuan Jian;Yuan Xianrui;Liu Qing(Department of Neurosurgery,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院神经外科,长沙410008

出　　处：《中华神经医学杂志》2019年第6期593-598,共6页Chinese Journal of Neuromedicine

摘　　要：目的探讨侵袭海绵窦的大型及巨大型垂体腺瘤的临床治疗策略。方法中南大学湘雅医院神经外科自2010年1月至2018年12月收治109例侵袭海绵窦的大型及巨大型垂体腺瘤患者,其中4例泌乳素型垂体腺瘤患者口服溴隐亭药物治疗,余105例患者行手术治疗,手术入路的选择根据垂体腺瘤的分型来确定。本研究回顾性分析不同手术治疗方式患者的临床资料和疗效。结果105例垂体腺瘤中Ⅰ型63例(60%)、Ⅱ型15例(14.3%)、Ⅲ型18例(17.1%)、Ⅳ型9例(8.6%);行扩大显微经蝶窦入路手术75例,行开颅手术26例,行开颅+扩大显微经蝶窦入路手术4例;肿瘤全切除86例,次全切除17例,大部分切除2例。术后新增颅神经麻痹10例,其中动眼神经麻痹7例,外展神经麻痹3例;2例术前神经功能麻痹加重,均为动眼神经;短暂性尿崩19例,电解质紊乱23例;无永久性尿崩、脑脊液漏及颅内感染,无术后新发视力视野障碍及视力视野障碍加重。结论合理的临床治疗策略和恰当的显微外科手术方式可使侵袭海绵窦的大型及巨大型垂体腺瘤患者获得良好的治疗效果。Objective To investigate the clinical treatment strategy of large and giant pituitary adenomas invading the cavernous sinus.Methods One hundred and nine patients with large and giant pituitary adenomas invading the cavernous sinus,admitted to our hospital from January 2010 to December 2018,were chosen in our study.Four patients with prolactin-type pituitary adenomas received oral treatment with bromocriptine;the remaining 105 patients received surgical treatment,and choices of surgical approach were based on classification of pituitary adenomas.The clinical data and efficacies of these patients accepted different treatment approach were retrospectively analyzed.Results Of the 105 patients with pituitary adenomas,63 (60%) were of type Ⅰ,15 (14.3%) were of type Ⅱ,18 (17.1%)were of type Ⅲ,and 9 (8.6%) were of type Ⅳ.Single extended transsphenoidal approach was used in 75 patients,transcranial approach was used in 26 patients,and combined extended transsphenoidal and transcranial approach was used in 4 patients.Gross total tumor resection was achieved in 86 patients,subtotal resection in 17 patients,and partial resection in two patients.Ten patients had new cranial nerve palsy after surgery,including 7 with oculomotor nerve palsy and three with abductor nerve palsy;two patients with preoperative neurological paralysis were aggravated,and both of them were oculomotor nerves;transient insipidus was noted in 19 patients and electrolyte disorder was noted in 23 patients;no permanent insipidus,cerebrospinal fluid leakage or intracranial infection,and no new or aggravated visual field vision disorder were noted.Conclusion Reasonable clinical treatment strategies and appropriate microsurgical approaches can achieve good therapeutic effect in patients with large and giant pituitary adenomas invading the cavernous sinus.

关 键 词：海绵窦 垂体腺瘤 治疗策略 泌乳素 

分 类 号：R739.4[医药卫生—肿瘤]