垂体腺瘤的手术入路选择(附鞍区显微解剖研究及113例报告)

Choice of surgical approach for pituitary adenomas: microsurgical anatomy of sellar region and clinical report of 113 cases

目的探讨手术治疗垂体腺瘤的合理入路。方法对15例标本进行鞍区显微解剖观察,并回顾性分析113例垂体腺瘤的手术观察结果和经验教训,进行对照研究。结果国人鞍结节较平坦,经间隙I手术困难不大;间隙Ⅱ大多狭小,不利于外侧入路的展开,常增加视路并发症。经蝶入路可提供较好的肿瘤显露,治疗结果较好。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,但额下入路手术效果并不悲观,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采用经翼点入路。

Objective To investigate the reasonable surgical approach for pituitary adenomas. Methods Operative space in the sellar region was observed microanatomically in 15 formalin-fixed cadaveric heads. Intra-operative observation and experience with 113 operations for pituitary adenomas were analyzed retrospectively. Structure of the surgical space was measured and described. The outcomes were compared. Results Tuberculum sellae of Chinese people was rather smooth. Space I was easily adopted. Space II, usually narrow, precluded the operation via exterior approach and increased complications of visual pathway. Transsphenoidal approach provided better tumor exposure and therapeutic effect due to avoidance of these structures and spaces. Conclusions As difference in tumor configuration, choice of approach should be individualized. Single-nostril approach is most deserved commendation. Subfrontal approach is not so pessimistic as before. Supraorbital keyhole approach shows a wonderful prospect. Tumors distinctly spreading to the parasellar region should still be removed via pterional approach.