再次经蝶入路手术切除垂体腺瘤体会

Repeat transsphenoidal surgery for pituitary adenoma

目的探讨再次经蝶人路手术（TSS）切除垂体腺瘤的手术策略。方法回顾性收集自2003年1月至2012年10月福州总医院收治的23例再次TSS治疗垂体腺瘤患者的临床资料，分析其手术方法与治疗结果。结果本次TSS均在显微镜下完成，4例采用神经导航引导手术，1例使用C臂机透视定位。肿瘤高度1545mm。全切除肿瘤12例，次全切除和大部切除10例，部分切除1例。有10例术中发生脑脊液漏。18例获得随访，术后出现展神经麻痹1例，长期尿崩1例，需依赖激素替代治疗1例。结论再次TSS应尽可能更新手术进路，扩大肿瘤的显露范围，并警惕脑脊液漏的发生。

Objective To explore the strategies of repeat transsphenoidal surgery （TSS） for pituitary adenomas. Methods Surgical techniques and treatment outcomes of 23 patients with pituitary adenomas, performed repeat TSS in our hospital from January 2003 to October 2012, were retrospectively analyzed. Results All repeat TSS were done under a microscope; four patients were performed navigation-guided surgery and one patient used C-arm fluoroscopy. The tumor heights were 15-45 mm, and the tumors were total removed in 12 cases, subtotal resection or most resection in 10 cases and partial removal in 1 case. There were 10 cases of cerebrospinal fluid leakage during operation. Eighteen cases were followed up, with postoperative abducens nerve palsy and long-term diabetes insipidus in one each case, and one case needed the hormone replacement therapy. Conclusion Repeat TSS should correct surgical approach as much as possible and enlarge the tumor＇ s exposure, and should be alert to the occurrence ofcerebrospinal fluid leakage.