经蝶窦垂体腺瘤切除术中鞍底的处理

Management of the Sellar Floor During the Transsphenoidal Pituitary Adenoma Surgery

目的 探索改进经蝶窦垂体腺瘤切除术中的鞍底处理方法。方法 对本院1995年以来82例经蝶窦显微手术的垂体腺瘤患者,按鞍底处理分为三类。术中满意切除腺瘤,鞍隔蛛网膜囊满意贴向鞍底者,用明胶海绵加EC胶单纯封闭鞍底(29例);术中蛛网膜破损有脑脊液漏出者,用明胶海绵加EC胶封堵(37例);对肿瘤刮除不满意或刮除肿瘤后鞍隔蛛网膜下降不满意者,鞍内填入明胶海绵或速即纱等止血物质,鞍底敞开不封闭(16例)。结果 患者术后均无不良反应,也没有并发症。结论本方法与目前传统方法的最大区别在于处理鞍底不用自体游离组织,而用明胶海绵、EC胶。其方法简便,安全,疗效可靠,且减少患者的痛苦。

Objective To explore the techniques for repairing of the sellar floor after transsphenoidal resection of the pituitary adenoma. Method Since 1995, 82 patients received transsphenoidal neurosurgery for resection of the pituitary adenoma. The techniques used in management of the sellar floor could be classified into 3 types:① In the 29 patients the sellar floor were simply obliterated with gelatin sponge and EC glue;② In the 37 patients with teared sellar diaphragm and CSF leakage the sellar floors were sealed by three layers of gelatin sponges and EC;③ In the 16 patients whose tumors could not be completely removed the sellar floors remained open. Results The operative results were satisfactory. No untoward reactions and postoperative complications were found. Conclusion The present technique which needed the gelatin sponge and EC glue was different from the conventional therapeutic method for which the free autogenic tissues were necessary. This technique is simple, safe, relatively reliable, and less suffering to the patients.