垂体腺瘤显微手术入路的选择应用

Choice of surgical approach for the pituitary adenomas

目的本文总结各种垂体腺瘤显微手术的入路、方法及手术后的效果,分析其术后并发症发生的原因,探讨可采取的预防措施,以便于临床更科学、更合理地选用垂体瘤切除术式。方法回顾性分析了2003年1月至2006年6月经CT、MRI及内分泌检查确诊的垂体腺瘤197例;其中经翼点入路切除肿瘤21例;经额入路切除肿瘤9例;经蝶入路(包括单鼻孔入路)切除肿瘤167例。结果经翼点入路全切除肿瘤14例、次全切除肿瘤2例、大部分切除肿瘤5例;经额入路全切除肿瘤6例、大部分切除肿瘤1例、次全切除肿瘤2例。经蝶入路全切除肿瘤148例;次全切除肿瘤14例;部分切除肿瘤5例。复发率:经翼点入路病例中2例复发;经额入路病例中1例复发;经鼻蝶入路病例中6例复发。结论在严格掌握各种手术入路适应证的情况下,取各自的优点,目前经单鼻孔蝶窦入路手术具有颅内干扰轻,视神经减压充分,视力改善理想,并发症少,恢复快,不影响外观,术中显露满意,内分泌紊乱纠正较完全等优点,已基本取代其他入路。对于巨大型垂体腺瘤,肿瘤向鞍上和颈内动脉两侧膨胀生长,手术可选二种入路或分二期进行,以期望提高全切率、降低死亡率和复发率、减少并发症。

Objective To summarize the different surgical approaches, methods and the effects in microsurgical therapy for pituitary adenomas, analyze the reason of postoperative complications, and discuss the measures of prevention to provide proper and scientific therapy for the pituitary adenomas. Method Retrospectively analyzed postoperative outcomes of pituitary adenoma in 197 cases from January 2003 to June 2006 that had been final diagnosed by CT, MRI scan and endocrine examination. Operations had been performed only via the pterional eraniotomy in 21 cases; via the frontal eraniotomy in 9 eases; only via mierosurgery through transsphenoidal approach in 167 cases. Results Via pterional craniotomy, total removal in 14 cases; subtotal removal in 2 cases, and most removal in 5 cases; via frontal approach craniotomy, total removal in 6 cases, subtotal removal in 2 cases, most removal in 1 case; via transsphenoidal approach, total removal in 148 cases, subtotal removal in 14 cases , part removed tumor in 5 cases. Two cases via ptefional craniotomy were reck, including 1 case via frontal approach craniotomy and 6 cases via transsphenoidal approach. Conclusion The results show that the sphenoid approach has the advantages of mere indications. Microsurgical therapy combined with the naso-vestibulo-septum-sphenoid approach and the pterional or frontal approach craniotomy for giant adenoma is applied in order to increase the total removal rate and decrease the mortality, recurrence and complications.