单鼻孔经蝶入路切除垂体微腺瘤

Microsurgical treatment of pituitary microadenoma via transnasal transsphenoidal approach

目的探讨垂体微腺瘤的治疗理念和手术技术。方法报告15例手术,分析其经验和教训。结果临床诊断PRL腺瘤10例,GH腺瘤2例,ACTH腺瘤3例。手术全切肿瘤13例,大部切除2例,2例病理未证实肿瘤。男性PRL腺瘤疗效差,ACTH腺瘤手术切除常有一定难度。结论并非所有垂体微腺瘤都适于手术,宜慎重掌握手术指征。术中强调正确利用局部解剖关系,准确定位,合理止血,争取彻底切除。

Objective To explore the treatment strategy and surgical technique of pituitary microadenoma. Methods The experience and lessons of 15 cases of surgery were analyzed. Results 10 cases with PRL adenoma, 2 with GH adenoma, and 3 ACTH adenomas were diagnosed clinically. The tumors were totally removed in 13 cases and sub-totally removed in 2. Tumor was not identified in 2 cases pathologically. The clinical results of PRL pituitary adenoma in male were not satisfied. It was often much difficult to remove the whole ACTH adenoma. Conclusions Not all of the pituitary microadenoma are suited for surgical treatment, and the surgical indications should be mastered cautiously. The accurate orientation could be achieved by referring correctly the topographic anatomy. The proper homeostasis and total removal should be achieved by great efforts.