内镜经鼻蝶入路手术治疗老年人垂体腺瘤

Endoscopic endonasal transsphenoidai surgery for pituitary adenoma in elderly patients

目的 探讨内镜经鼻蝶入路手术治疗老年人垂体腺瘤的技术和方法. 方法 对2003年6月至2012年6月间治疗的42例老年垂体腺瘤患者进行回顾性分析,术前均行头CT、MRI及内分泌学检查,手术采用内镜经鼻蝶入路肿瘤切除术. 结果 本组患者中肿瘤全切除25例（59.5％）,近全切除8例（19.1％）,部分切除9例（21.4％）,死亡1例.术后随访6～36个月,患者视力、视野障碍均有所改善,20例需激素替代治疗,肿瘤残余12例,5例行伽马刀治疗. 结论 内镜经鼻蝶入路手术是治疗老年人垂体腺瘤微创、安全的方法,加强围术期处理是手术成功的关键.

Objective To discuss the operative techniques of endoscopic endonasal transsphenoidal surgery for the resection of pituitary adenoma in elderly patients.Methods From June 2003 to June 2012,a retrospective analysis of 42 elderly patients with pituitary adenoma was conducted.Computed tomography （CT） scan,magnetic resonance imaging （MRI） scan,and endocrinological examinations were performed in all patients before operation.All patients underwent endoscopic endonasal transsphenoidal surgery for the resection of pituitary adenoma.Results The tumors were totally removed in 25 cases （59.5%）,sub-totally removed in 8 cases （19.1%） and partly removed in 9 cases （21.4%）.1 patient died after operaion.Patients were followed up for 6-36 months.The visual acuity and visual field were improved.Hormone replacement therapy were needed in 20 patients due to hypopituitarism.Tumor residuals were found in 12 patients,among whom 5 patients were treated by γ-knife radiosurgery.Conclusions The endoscopic endonasal transsphenoidal operation is minimally invasive and safe for the treatment of pituitary adenoma in elderly patients.The strengthening of perioperative management is the key to the successful operation.