经鼻蝶入路显微手术治疗垂体卒中的临床分析

Clinical Analysis of Microsurgically Treating Pituitary Apoplexy through Endonasal Transsphenoidal Approach

目的总结55例垂体卒中患者的临床表现特征,分析经鼻蝶入路显微手术的疗效。方法回顾性分析经鼻蝶入路显微手术治疗的55例垂体卒中患者的临床和影像学资料。结果本组55例垂体腺瘤中,48例全切除,7例次全切,肿瘤全切率为87.3%。51例视力障碍、视野缺损的患者中46例术后恢复正常(90.2%),5例恢复欠佳;32例伴有内分泌症状的患者中29例明显缓解(90.6%),3例无明显变化。术后一过性尿崩症7例,脑脊液漏5例。无死亡病例5例。结论根据突发头痛及视路症状等相关症状、体征并结合影像学检查一般可确诊垂体卒中;经鼻蝶入路显微手术和/或内窥镜手术可做为治疗垂体卒中的首选方法。

Objective To summarize the clinical manifestations of 55 patients with pituitary apoplexy and to analyze the curative effect of microsurgery through endonasal transsphenoidal approach on the pituitary apoplexy. Method The clinical and radiologic data of 55 patients with pituitary apoplexy, who were treated by microsurgery through the endonasal transsphenoidal approach, were analyzed retrospectively. Results Of the 55 cases of pituitary adenomas treated by microsurgery through the endonasal transsphenoidal approach, 48 were totally resected and 7 subtotally. In 51 patients with sight disturbance and visual field defect before the operation, the sight and visual field were recovered very well in 46 patients and bad in 5 after the operation. Of 32 patients with endocrine disturbance before the operation, 29 were improved in endocrine symptom and 3 not. There was temporal diabetes insipidus in 7 patients and cerebrospinal fluid rhinorrhea in 5. No patients died of the operation. Conclusions Pituitary apoplexy can be diagnosed as according to clinical manifestations including headache attack, visual pathway disturbance and so on in combination with its radiological characteristics. The microsurgery and endoscope-assisted microsurgery through endonasal transsphenoidal approach are recommended as the preferential method to treat pituitary apoplexy.