经蝶及双额底入路治疗垂体腺瘤的手术选择

A Clinical Analysis of Pituitary Adenomas Resected via the Transsphenoidal or Transcranial Approach

背景与目的:垂体腺瘤手术分为经蝶和经颅入路两种,常根据不同的情况选择合适的手术入路,这与肿瘤的全切除程度和术后疗效密切相关。本研究探讨经单鼻孔-蝶窦及双额底入路治疗垂体腺瘤的手术适应证、显微外科技术及疗效。方法:回顾性分析47例垂体腺瘤手术患者,其中经单鼻孔-蝶窦手术30例,经双侧额底入路手术17例,分析手术经过、治疗效果和随访情况。结果:肿瘤总体全切率89.36%(43/47),其中经单鼻孔-蝶窦入路组86.67%(26/30),经双额底入路组94.12%(16/17)。肿瘤未获全切者术后辅以放射治疗。随访6～24个月,4例患者肿瘤复发,接受经双额底入路手术后恢复良好。结论:经单鼻孔-蝶窦入路手术治疗垂体腺瘤创伤小、恢复快,适用于肿瘤大部分位于鞍内或向蝶窦生长的患者。经双额底入路肿瘤全切率高,便于保护垂体柄,适用于肿瘤主要向鞍上及鞍旁生长的大型或巨大型肿瘤。

BACKGROUND＆OBJECTIVE： Pitoitary adenomas were commonly removed through the transsphenoidal or transcranial approach. The ideal operative approach should be based on clinical history and radiological data, which was associated with the resection extent and prognosis. In this study, we investigated the operative indications, microsurgical skills and efficacy of transsphenoidal and transcranial approach to remove pituitary adenomas. METHODS： According to the different growing manner of pituitary adenomas, 30 eases were treated through the transsphenoidal approach and 17 via the trans-subfi＇ont bilateral approach. RESULTS： The total resection rate of pituitary adenomas through the two approaches was 89.36% （43/47）. The total resection rate of transsphenoidal operation was 86.67% （26/30）, and that of transcranial operation was 94.12% （16/17）. All the patients were followed up for 6-24 months. Tumors recurred in 4 cases in transcranial approach treated group and were then re-operated via the transcranial approach. CONCLUSION： The transsphenoidal approach is ideal to remove adenomas growing towards the sphenoidal sinus and inner saddle region while transcranial approach is suitable for large or giant adenomas growing towards the upper saddle region and parasaddle.