大型垂体腺瘤经蝶显微外科治疗技术要点

MAIN TECHNICAL POINTS OF TRANSSPHENOIDAL MICROSURGICAL REMOVAL FOR LARGE PITUITARY ADENOMAS

报道经蝶显微手术治疗大型垂体腺瘤145例,均经CT扫描或MRI确诊,肿瘤向鞍上扩展直径>10mm。在手术显微镜下经唇下—鼻中隔—蝶窦入路或经鼻前庭—鼻中隔—蝶窦入路两种方式行肿瘤切除术。术中于腰蛛网膜下腔予置一导管,用于注射生理盐水,增加颅内压力,使鞍上瘤块进入手术野,以利切除。102例(70.4％)肿瘤获全切除;35例(24.1％)达次全切除;余8例(5.5％)系哑铃型或纤维性腺瘤,行部分切除。术后无死亡。132例平均随访观察3.5年,其中93例(70.5％)恢复良好,39例(29.5％)肿瘤复发,需再次手术,或采用药物、放疗或放射外科治疗。文中对本型肿瘤经蝶显微外科处理的方法与技术要点进行了讨论。

Large pituitary adenomas were treated by transsphenoidal microsurgery on 145 patients. The diagnosis was made by means of CT or MRI scan. The suprasellar extension of the tumors were all above 10mm in diameter. Operations were performed via either sublabio-septo-sphenoidalapproach or naso-vestibulo-sphenoidal approach under microscope. During the operation, normal saline was slowly injected through a subarachnoid catheter into the lumbar cistern in order to increase the ICP and deliver the suprasellar portion of the tumor into the operative field. Total removal of the tumor in 102 cases (70.4% ) and subtotal removal in 35 cases (24. 1 % ) were achieved. The remaining 8 cases with fibrous of dumbbell-shaped tumors underwent partial removal only. There was no postoperative mortality. Long term follow-up (median 3. 5 years) in 132 patients revealed good recovery of 93 patients (70. 5% ), and late recurrence in 39 case (29. 5%). The patients with recurrence need re-operation, drug therapy, radiotherapy, or radio-surgery either alone or combined. The management and main technical points of transsphenoidal microsurgery for the tumor were discussed in the paper.