鞍区大型肿瘤不同显微手术入路的疗效评估（附82例报道）

Assessment of different microoperation approaches for removal of large tumors in the sellar region

目的探讨和评估大型鞍区肿瘤不同手术入路的疗效。方法福建医科大学附属漳州市医院神经外科和上海同济大学附属仁济医院神经外科自2004年1月至2012年1月采用不同的手术入路治疗鞍区大型肿瘤患者82例，其中双额底内侧人路32例，单鼻孔经蝶人路32例．扩大的翼点人路12例、单侧额下外侧人路6例，评估不同人路的结果和预后。结果本组肿瘤全切除66例，次全切除16例，其中经双额底内侧人路肿瘤全切除28例（87．5％、，次全切4例；单鼻孔经蝶经入路肿瘤全切除26例（81．2％），次全切6例；扩大的翼点人路肿瘤全切除9例（75％），次全切3例；单侧额下外侧入路肿瘤全切除3例（50％），次全切3例。无手术死亡患者。结论鞍区大型肿瘤的切除可根据肿瘤类型选用经扩大的翼点入路或双额底内侧人路，单鼻孔经蝶人路主要适用于垂体腺瘤。

Objective To investigate and assess the efficacy of different operation approaches in removal of large tumors in the sellar region. Methods Eighty-two patients with large tumors in the sellar region, admitted to and performed operation via four approaches in our hospital fi＇om January 2004 to January 2012, were chosen in our study; 32 of them chose bifrontal basal interhemispheric approach, 32 single nostril transsphenoidal approach, 12 expanded pterional approach and 6 unilateral subfi＇ontal anterolateral approach. The results and prognoses of different operation approaches for different types of tumors were compared. Results Total resection of the tumors was achieved in 66 patients and subtotal resection in 16 patients. Total resection and subtotal resection of the tumors via bifrontal basal interhemispheric approach were achieved in 28 patients （87.5%） and 4 patients, respectively; total resection and subtotal resection of the tumors via single nostril transsphenoidal approach were achieved in 26 patients （81.2%） and 6 patients, respectively; total resection and subtotal resection of the tumors via extended pterlonal approach were achieved in 9 patients （75 %） and 3 patients, respectively; total resection and subtotal resection of the tumors via unilateral subfi＇ontal anterolateral approach were achieved in 3 patients （50 %） and 3 patients, respectively. No patients died. Conclusion The removal of large tumor in the sellar region can be operated by the extended pterlonal approach or bifi＇ontal basal interhemlspheric approach according to the type of tumors; single-nostril transsphenoidal approach is mainly applicable to pituitary adenoma.