二次经鼻蝶入路垂体瘤显微切除术45例

Transsphenoidal Reoperation on Pituitary Adenomas:A Report of 45 Cases

目的探讨经鼻蝶入路二次手术切除垂体腺瘤的手术方法和技巧,并总结术后通过综合治疗增加缓解率及预防并发症的经验。方法回顾性分析同济医院神经外科2005年1月至2010年11月二次经鼻蝶入路垂体瘤手术治疗的45例患者的临床资料,对手术切除程度,术后视力和内分泌的变化及并发症,术后综合治疗方法等进行总结和分析。结果患者全切加次全切除率达到81.3%,术前视力有障碍者术后好转率100%,功能性垂体腺瘤患者40.9%恢复正常,余患者均有不同程度好转。无死亡病例,无严重并发症病例出现。结论对于垂体瘤复发或残余患者,若存在手术适应证,再次经鼻蝶手术依旧是疗效最确切且相对十分安全的治疗手段,可作为治疗首选,配合药物和(或)放疗的综合治疗将能进一步提高疗效。

Objective To explore the surgical procedures of transsphenoidal reoperation on pituitary adenomas and to summarize the experiences of the comprehensive treatments after operation for increasing the remission rate and in preventing the postoperative complications.Methods The clinical data of 45 patients with pituitary adenomas,who underwent the transsphenoidal reoperation for pituitary adenomas between Jan.2005 and Nov.2010 in Department of Neurosurgery,Tongji Hospital,were reviewed.The extent of resecting tumors,changes in the vision,visual field and endocrinology as well as the postoperative complications and comprehensive treatments were analyzed retrospectively.Results 81.3% patients received total and subtotal resections.All patients suffering from the vision and visual field disturbance had more or less gained ground.The level of blood hormone in 40.9% patients with functional adenomas returned to the normal following the operation and the rest obtained improvements to varying degrees.No severe complications occurred and there were no deaths.Conclusion Transsphenoidal reoperation has still the most obvious curative effect and also relative safety for the patients with recurrence or remnant pituitary adenomas who have the operation indications and can be the preferred treatment choice for these patients.The curative effect could be further improved when the drug therapy and radio therapy were given.