经眶-额下入路显微手术切除大型、巨大型垂体腺瘤技术探讨

Microsurgecal technique of unilateral transorbital subfrontal approach for large and giant pituitery adenoma

目的 介绍 1998～ 1999年内显微手术切除 82例大型、巨大型垂体腺瘤的操作技术及经验。方法 所有病人采用单侧经眶额下入路。先于囊内切除鞍内及鞍上的肿瘤 ;电灼并断肿瘤供血血管 ;沿鞍膈四周一圈 ,分块切除鞍上瘤壁 ;鞍内瘤壁予以电凝。结果 全切肿瘤及鞍上的瘤壁 ,电凝处理鞍内的瘤壁 ,同时保留好垂体柄者 5 9例 (72 % ) ,其余均为次全切除。术后恢复正常生活或工作 78例 (95 1% ) ,尿崩 6 1例 (74 4% ) ,死亡 1例 (1 2 % )。结论 采用单侧经眶、额下入路 ,进行显微手术 ,不仅能明显提高大型、巨大型垂体腺瘤的全切率 ,而且可以同时切除鞍上的瘤壁 ,处理鞍内的瘤壁 。

Objective To introduce the microsurgcal operative technique and our experience of 82 cases of large and giant pituitary adenoma in 1998.and 1999.Methods All patients were operated via the unilateral transorbital subfuontal approach. The key points of tumor resection were as follows: 1. The intrasellae and suprasellae parts of the tumor were removed. 2. After internal decompression of the pitutary adenoma, the tumor wall was dissected freely from the base of the normal brain tissue. 3. Numerous new fine tumor vessels arising from the optic nerves, the chiasm, the dura mater, and the carotid artery were coagulated and cut. 4. The suprasellar part of the tumor wall was resected by piecemeal . 5. The pituitary stalk located in the posterior part of the tumor wall was protected carefully.Results Total removal of the tumor, excision of the suprasellae portion of the capsule of the tumor, and coagulation of the intrasellae portion of the tumor wall were achieved in 59 cases (72%). The others were subtotally removed. One case was died (1 2%)after operation.Conclusions Microsurgical technique via unilateral transorbital subfrantal approach can improve the total remove rate, reserve the pituitary stalk, excide the suprasellae portion of the capsule of the tumor of large and giant pituitery adennoma, and can coagulate the intrasellae portion of the tumor wall. All of these lay solid foundations for preventing tumor recrudescence.