SSE垂体无功能巨腺瘤术后残余肿瘤的转归与处理

Study on the Turnover and Treament of Postoperative Residues of Giant Nonfunctioning Pituitary Adenoma with Suprasellar Extension (SSE)

目的:探讨鞍上扩展(the suprasellar extension,SSE)的垂体无功能巨腺瘤手术治疗后残余肿瘤的转归与处理措施。方法:回顾性分析我科首次手术治疗为经蝶入路的资料齐全的68例巨大型SSE垂体无功能腺瘤患者的临床资料,重点分析肿瘤的术中处理,术后肿瘤的残余情况、随访过程中残余肿瘤的转归及其相应的处理措施。结果:一期手术SSE肿瘤全切者20例(20.6%),术后第1天MRI复查存在鞍上残余肿瘤者48例(79.4%);术后3个月复查,残余肿瘤21例下降至鞍窝底,8例下降至鞍窝内。3例下降至垂体柄水平和鞍窝入口处(下降率为66.7%),均采用再次经蝶手术切除(下降后残余肿瘤的全切除率96.9%);2例患者肿瘤虽然下降,但仍为明显的伴有SSE的残余肿瘤,采用开颅切除;其余的12例有残余肿瘤的患者由于术后MRI显示残余肿瘤小采取持续临床观察,其中2例视力改善不明显者辅以伽马刀治疗。本组无死亡病例;没有患者发生术后脑脊液漏,脑膜炎或视力恶化:有2例术后常规的CT检查中观察到鞍隔上少量出血但不需特殊处理。结论:巨大型SSE垂体无功能腺瘤宜采用分期经蝶手术切除治疗,疗效确切,并发症少;有关垂体腺瘤的生长方式问题尚需进一步研究。

Objective： To explore the turnover and treament of postoperative remainder of giant nonfunctioning pituitary adenoma with suprasellar extension （SSE）. Methods： The clinical data of 68 cases suffering from giant nonfunctioning pituitary adenoma with suprasellar extension （SSE） admitted into our department were retrospectively analyzed. These patients underwent primary transsphenoidal surgery. Results： Twenty cases had SSE adenomas totally removed （20.6%）. In other 48 cases （79.34%）, SSE residues were shown in MRI recheck at one day after surgery. After 3 months, the 3rd MRI scanning was performed only to find that tumor residues descended to sellar floor in 21 cases, into intrasella in 8 cases, and down to the level of stalk hypophysial and the entrance to the sella in 3 cases. All of patients with residual tumors received retranssphenoidal resection （the total removal rate of desending SSE residues was 96.9%）. There were 2 cases with adenoma residues with slight descending. Obvious SSE adenomas were treated with transtranial approach. The twelve cases with small SSE residues were consecutively observed and two of them received gamma knife treatment because of unobvious postoperative visual improvement. The surgical mortality was 0%. There was no death during follow up in all of these patients. There were no cases with rhinorrhea, meningitis or visual deterioration. Two patients had supradiaphragmatic bleeding detected by routine postoperative CT. Conclusion： Staged surgery with two or multiple transsphenoidal resections is an appropriate treatment for giant nonfunctioning pituitary adenoma with suprasellar extension （SSE）, with few complications. Futher study is warranted to investigate the growth pattern of pituitary adenoma.