垂体腺瘤经蝶窦显微手术的临床研究

Clinical study on the microsurgery via the sphenoid sinus in the treatment of pituitary adenoma

目的探讨垂体腺瘤经蝶窦的手术途径和处理策略.方法回顾性总结1992年～2004年68例垂体腺瘤经蝶手术的临床资料和疗效,术前行蝶窦断层Ⅹ片、CT及MR检查,充分地了解蝶窦的气化程度和蝶窦的分隔.其中经唇下-鼻中隔-蝶窦入路7例;经鼻前庭-鼻中隔-蝶窦入路53例;经单鼻孔-蝶窦直接入路8例.结果全切除48例(70.6%),大部分切除18例(26.5%),部分切除2例(2.9%).无脑脊液漏和颅内感染发生;暂时性尿崩症2例,无永久性尿崩;未发生神经功能缺损,无手术死亡.随访1 3年内分泌症状56例中,28例恢复正常,20例改善,8例同术前.结论经鼻前庭-鼻中隔-蝶窦入路显露理想,适应于各种类型垂体腺瘤;经单鼻孔-蝶窦直接入路省时、简捷,尤其适应于中小型垂体腺瘤;经唇下-鼻中隔-蝶窦入路显露理想,但有创伤大、耗时长等缺点.术前熟悉蝶窦的分隔是预防经蝶手术'迷途'的关键.

Objective To explore the operative approachs and therapeutic strategies in the treatment of pituitary adenoma. Methods The clinical data and therapeutic results of 68 pituitary adenoma cases who underwent trans-sphenoidal microsurgery during 1992-2004 were analyzed retrospectively. Before the treatment, we comprehended adequately the gasification degree and the partition of sphenoid sinus by X-ray,CT and MR. The operative approaches are respectively sublabial-nasal septum-sphenoid sinus in 7 cases, nasal vestibule-nasal septum-sphenoid sinus in 53 cases and single nostril-sphenoid sinus in 8. Results Total removal ofadenomas was achieved in 48 cases （70.6%）, most removal in 18 （26.5%）, partial removal in 2 （2.9%）. There was no cerebrospinal fluid leak, intracranial infection, permanent diabetes insipidus, neurologic impairment and death, but temporary diabetes insipidus in 2 cases. In the 13-year follow-up, among 56 cases with endocrine symptoms, 28 got recovered, 20 improved and 8 unchanged. Conclusion The approach of nasal vestibule-nasal septum-sphenoid sinus offer a satisfied exposure of adenoma, suitable for all kinds of pituitary adenomas; single nostril-sphenoid sinus approach has an advantage of convenience and rapidness, especially for moderate or small adenomas; sublabial-nasal septum-sphenoid sinus can expose well the adenomas but lead to severe injury and spend too long time. The key of Trans-sphenoidal microsurgery is to be familiar with the gasification degree and partition of sphenoid sinus.