垂体微腺瘤的显微手术治疗

Microsurgical Treatment of Pituitary Microadenoma

目的探讨垂体微腺瘤经鼻蝶显微切除手术治疗选择及手术技巧。方法回顾性分析2008年7月～2011年12月37例垂体微腺瘤经鼻蝶显微手术治疗的临床资料。肿瘤直径5～10mm29例，2～4mm8例。36例为功能性腺瘤，其中泌乳素（PRL）腺瘤18例，促肾上腺皮质激素（ACTH）腺瘤13例，混合型腺瘤1例，生长激素（GH）腺瘤4例；无功能腺瘤1例。结果术后无功能性腺瘤1例头痛症状消失。PRL腺瘤和混合性腺瘤19例中泌乳7／7例停止，闭经10／13例恢复，其中3／5例不孕患者术后36个月内怀孕。库欣综合征13例中症状明显改善10例，无效3例。GH腺瘤4例肢端肥大现象均改善。结论垂体微腺瘤显微手术治疗应结合临床症状、内分泌检测和MRI检查结果综合判断。功能性垂体微腺瘤经单鼻孔蝶窦入路显微手术安全，有效。其中PRL腺瘤手术效果明显，ACTH腺瘤手术应注意争取全切，必要时可考虑放射治疗。

Objective To explore the surgical treatment of pituitary microadenoma. Methods The clinical data of 37 patients with pituitary microadenomas treated by transsphenoidal microsurgery from July 2008 to December 2011 were analyzed retrospectively. The tumor diameter of 29 cases was 5 - 10 ram, and that of 8 cases was 2 - 4 mm. There were 36 cases of functional adenoma, including 18 cases of prolactinoma, 13 cases of ACTH-secreting adenoma, 1 case of mixed adenoma and 4 cases of GH- secreting adenomas. There was 1 case of non-functional adenoma. Results Headache disappeared in the non-functional adenoma case after the surgery. Of the 19 prolactinomas or mixed microadenomas, 7/7 cases stopped galactorrhea and 10/13 amenorrhoea recovered, including 3/5 infertile patients being pregnant 36 months after the surgery. In the 13 cases of Cushing＇ s syndrome, the symptom of l0 cases improved, and 3 cases showed no improvement. Four cases of GH adenoma acromegaly all improved. Conclusions Pituitary microadenoma microsurgery treatment should be carried out based on clinical symptoms, endocrine examination and MRI results. Endonasal transsphenoidal microsurgery is a safe and effective method for functional pituitary microadenoma. Prolactinoma surgery is effective and fur ACTH-secreting adenoma surgery,total resection is recommended, and radiation therapy should be considered when necessary.