经蝶显微手术切除极大型垂体腺瘤

The transsphenoidal microsurgery for huge pituitary adenomas

目的:探讨经蝶入路显微手术切除极大型(直经>60mm)垂体腺瘤的可行性和适应证。方法:本组24例均经蝶入路手术,并依肿瘤的主体部位分为三型,即颅外型:肿瘤大部分在蝶鞍下方,共4例; 鞍内型:肿瘤在鞍内及鞍上的体积大致相等,共14例;鞍上型:肿瘤主体位于鞍上,共6例。结果: 9例(37. 5% )肿瘤全部切除, 7例(29. 2% )次全切除, 5例(20. 8% )大部切除, 3例(12. 5% )部分切除。5例根据复查残瘤的位置和大小再次选择经蝶(2例)或经颅(3例)二期手术。无严重并发征及死亡。结论:多数极大型垂体腺瘤可经蝶入路切除;与经颅相比,经蝶入路手术更为安全、有效、简便,但需要具备丰富的临床经验和技术水平;部分病例虽经蝶不能一次将肿瘤彻底切除,但可以使肿瘤体积缩小,使再次手术增加安全性;二期手术者需根据残瘤部位选择经蝶或经颅手术。

objective:To evalute the availability and indications of transsphenoidal microsurgery for huge pituitary adenoma(mor than 60 mm in diameter). Methods:All the tumors were removed by transsphenoidal approach firstly,and were classified into three types on the basis of the position of the tumor, namely, extracranial type ,the major part of the tumor in infrasellar ,in 4 cases; in-sellar type : the major part of the tumor roughly the same in sellar and suprasellar,in 14 cases; and suprasellar type : the major part of the tumor in suprasellar,in 6 cases. Results:Nine tumors(37.5%)were totally removed , seven(29.2%) were subtotally, Five (20.8%)were most partially and three(12.5%)were partially removed. There was no mortality nor severe complications.Conclusion:Transsphenoidal surgery for most of the patients with the huge pituitary adenoma is more safe, more effective and more simple as compared with the trancranial operation . But the operation requires a high level of technicals and rich clinical experience. Although the tumor in a part of cases can not be removed by radical at the first stage operation,the volume of the tumor is reduced, the two stage reoperation via transsphenoidal or transcranial approach was performed according to the position and size of the residual tumor safely.