鞍区显微解剖与垂体腺瘤手术入路研究

MICROSURGICAL ANATOMY OF THE SELLAR REGION AND CHOICE OF SURGICAL APPROACH FOR PITUITARY ADENOMAS

目的:探讨手术治疗垂体腺窟的合理入路。方法:取15个标本作鞍区的显微解剖观察,回顾性分析113例垂体腺瘤手术的观察和经验教训,进行对照研究。结果:国人的鞍结节较平坦,间隙1容易采用。许多间隙2狭小,妨碍了外侧入路的展开,并且增加了视路并发症。经蝶入路提供了更好的肿瘤显露和治疗结果。结论:入路选择要强调个体化原则,虽然经单侧鼻腔入路最值得推崇,但额下入路不象以前评价的那么悲观,其中眶上锁孔入路前景良好,由于肿瘤形态的差异,向鞍旁显著扩展的肿瘤依然需要经翼点入路完成。

Objective: To investigate the reasonable surgical approach for pituitary ademas.Method: Microsurgical anatomy of operating spaces in sellar region were observed in 15 formalin - fixed cadaveric heads. A retrospective study of intra - operative observation and experience was made on 113 operations on pituitary adenomas.The outcomes were compared. Results: Tuberculum sallae of Chinese people was rather smooth.Structures of the spaces were described and measured. Space 1 was easily adopted. Space 2, usually narrow, precluded the operation via lateral approach and increased complications of visual pathway. Transspenoidal approach provided better exposure and therapeutical effect.Conclusion: As difference of tumors configuration, choice of approach should be individualized. Single - nostril approach is most deserved to be commended. Subfrontal approach is not so pessimistic as before. Supraorbital keyhole approach shows a wonderful prospect. Tumors distinctly spreading to parasellar should still be removed via pterional approach.