经鼻蝶入路手术治疗垂体腺瘤48例报告

Transsphenoidal approach operation for pituitary adenoma:Report of 48 cases

目的探讨经蝶入路手术治疗垂体腺瘤的疗效。方法2000年1月～2005年12月对48例垂体腺瘤分别采用经口鼻蝶入路(17例)、经鼻蝶入路(31例)切除。经口鼻蝶入路,唇下黏膜切口,进入鼻前庭;经鼻蝶入路,右侧鼻孔进入,切开鼻中隔黏膜,最后均在两侧鼻中隔黏膜间形成通道,至蝶窦腹侧壁,打开蝶窦及鞍底,进入鞍内。结果全切37例,次全切除6例,大部切除5例。无手术死亡。15例术后一过性尿崩,7例脑脊液鼻漏。17例随访3～24个月,平均12个月,4例6个月后复发,4例怀孕生育下一代。结论对于无明显向蝶鞍外生长的垂体腺瘤,经蝶入路手术是安全可行的治疗方法。

Objective To study the effect of transsphenoidal approach operation for pituitary adenoma. Methods Transoral and transsphenoidal approach operations were performed in 17 patients with pituitary adenoma, and transnosal and transsphenoidal approach operations were performed in 31 patients with pituitary adenoma, from January 2000 to December 2005. For transoral and transsphenoidal approach operations, the upper lip mucous membrane was opened to introduce into the nasal cavity. For transnosal and transsphenoidal approach operations, the instruments were inserted by way of the right nostril, and the nasal septum was opened. During both of the approaches, a tunnel was established between both sides of the nasal septum, through which the sphenoidal sinus was opened, for entering the sella through the bottom. Results Total resection was completed in 37 patients, subtotal resection was completed in 6, and partial resection, in 5. No surgical-related death occurred. Postoperatively, transient hyperuresis was found in 15 patients, and cerebrospinal fluid rhinorrhea was seen in 7 patients. Seventeen patients were followed for 3 - 24 months （mean, 12 months）. Recurrence was encountered in 4 patients at 6 months after operation, Four patients were pregnant and delivered of a child. Conclusions For pituitay adenoma not obviously extending to the parasellar, transsphenoidal approach is a safe and effective option.