再次经鼻蝶入路切除复发或残留的垂体瘤

Endonasal transsphenoidal re-excision of recurrent or residual pituitary adenomas after transseptal microsurgery

目的：探讨经鼻蝶手术后复发或残留的垂体瘤再次经单鼻孔直达蝶窦入路显微外科手术的技术方法与疗效。方法：我科2001年8月至2005年8月对经鼻蝶手术后复发或残留的32例垂体瘤进行了经单鼻孔直达蝶窦入路显微外科再次手术治疗。结果：14例（43．8％）肿瘤获全切除，10例（31．2％）肿瘤达到次全切除，8例（25．0％）肿瘤仅获部分切除，无手术死亡。在垂体激素异常增高的13例功能性垂体腺瘤中，6例激素水平降至正常，3例激素水平下降〉50％，4例激素水平下降〈50％。24例术后随访观察6—48个月，8例（8／9）头痛消失或减轻；21例（21／22）视力、视野障碍改善；5例（5／7）肢端肥大症减轻；3例（3／4）溢乳停止，月经恢复。结论：经单鼻孔直达蝶窦入路显微外科手术最大限度的利用了鼻腔的自然间隙，具有入入路直接、创伤轻微和并发症少等优点；尽管有一定难度，但仍然是治疗经鼻蝶手术后复发或残留垂体瘤的一种安全有效的微创方法。

Objective： To evaluate the effect of endonasal transsphenoidal re-excision of recurrent or residual pituitary adenomas after transseptal microsurgery. Methods ：Thirty-two patients suffering from recurrent or residual pituitary adenomas after transseptal microsurgery were re-operated on by endonasal transsphenoidal surgery from October, 2001 to October, 2005. Results：Gross removal of tumors in 14 cases （43.8%） and subtotal removal in 10 cases （31.2%） were achieved. Partial removal was carried out in the remaining 8 cases （25%）. No death was happened postoperatively. Among the 13 patients with hormone-secreting adenomas, 6 cases got normal hormone levels, 7 cases improved clinically with decreased serum hormone levels. Six to forty eight months＇ follow-ups in 24 patients （75%） revealed that the post-/pre-operative improvements were as follows： diminished acuity and visual field defects, 21/22; headache, 8/9; acromegaly, 5/7; galactorrhea and amenorrhea, 3/4. Conclusion：Endonasal transsphenoidal re-excision of recurrent or residual pituitary adenomas after transseptal surgery can make maximal use of the natural space of nasal cavity, which has many advantages such as direct approach,minimal invasion, and less postoperative complications. It is the best approach for treating recurrent or residual pituitary adenomas in spite of some degrees of operative difficulties.