垂体腺瘤经蝶显微手术的疗效分析  

The clinical evaluation of patients with pituitary adenomas undergone transsphenoidal microsurgery

作　　者：赵曜[1] 李士其[1] 周良辅[1] 王镛斐[1] 寿雪飞[1] 贾丕枫[1] 

机构地区：[1]复旦大学附属华山医院神经外科,上海200040

出　　处：《中华外科杂志》2003年第8期610-613,共4页Chinese Journal of Surgery

摘　　要：目的　探讨经蝶显微手术治疗垂体腺瘤的临床综合疗效、手术技巧、新技术应用等。方法　对于 1997～ 2 0 0 1年经蝶显微手术治疗的 14 6 2例垂体腺瘤患者的临床资料、影像学、内分泌及病理检查结果、肿瘤切除率、术后并发症以及随访结果进行回顾性总结和分析。　结果　HardyⅠ级的肿瘤全切率已达 97 0 %、Ⅱ级 95 2 %、Ⅲ级 90 5 %、Ⅳ级 4 7 4 % ;术后患者临床症状及内分泌功能有显著改善 ,肿瘤复发率低 (0 3% )。　结论　随着神经显微操作技术的日益娴熟及新技术的应用 ,经蝶入路手术指征不断扩大 ,内窥镜和 (或 )神经导航辅助显微外科经鼻 蝶窦入路手术 ,是垂体腺瘤的首选治疗方法 ;Objective To evaluate the overall effect of transsphenoidal microsurgery for pituitary adenomas in recent 5 years and to discuss the surgical technique, application of new technology and postoperative follow up results. Methods The clinical presentation, image characteristics, endocrinal findings, pathological types, tumor removal percentage, postoperative complication and follow up of 1 462 patients with pituitary ademomas who underwent the transsphenoidal microsurgery from 1997 to 2002 were analysed retrospectively. Results Total rate of tumor removal for the patients achieved 97 0% in the patients with HardyⅠ adenomas, 95 2% with HardyⅡ, 90 5% with Hardy Ⅲ, and 47 4% with Hardy Ⅳ respectively. A significant postoperative improvement both in clinical symptoms and endocrinal paraments was achieved. The tumor recurrence rate was 0 3%. Conclusions With the improvement of microsurgical technique and application of novel technology, the indication of transsphenoidal microsurgery for pituitary adenomas was increasingly extended. Endoscope and (/or) neurpnavigator assisted microsurgery via transsphenoidal approach should be of the first choice for the treatment of pituitary adenomas.The routine postoperative radiotherapy is not required for patients with total tumor removal.

关 键 词：垂体腺瘤 显微外科 手术治疗 经蝶手术 手术技巧 

分 类 号：R736.4[医药卫生—肿瘤] R730.56[医药卫生—临床医学]