显微经蝶入路垂体腺瘤切除术垂体功能的保护策略

Protective strategies for pituitary function resection in pituitary adenoma resection by transsphenoidal approach

目的总结垂体腺瘤经蝶窦手术,术中垂体柄和垂体组织的辨认与保护的体会。方法显微镜下经鼻蝶入路切除的垂体腺瘤病人50例,通过影像学资料和术中显微解剖,仔细辨认正常垂体组织、垂体柄与病变组织的关系,尽可能切除垂体腺瘤组织,保护垂体功能,减少术后并发症。结果肿瘤全切除40例(80. 0%,40/50),次全切除8例(16. 0%,8/50),大部分切除2例(4. 0%,2/50)。术中垂体柄及正常垂体组织均保留良好。术后暂时性尿崩者8例(16. 0%,8/50),无永久性尿崩;术后随访3～12个月,所有病人垂体功能均明显改善。结论显微经蝶窦手术中,术者对正常垂体、垂体柄及肿瘤组织的准确辨认,才能达到保留垂体功能的治疗目标。

Objective To summarize the experience of identifying and protecting pituitary stalk and pituitary tissue during transsphenoidal surgery. Methods The clinical data of 50 cases suffering from pituitary adenomas undergoing transsphenoidal microsurgery were analyzed retrospectively. During the operations,we carefully identified the normal adenohypophysis,pituitary stalk,and the abnormal tissues either by direct observation or by medical images,aiming to excise the tumor thoroughly,protect the pituitary function and reduce the postoperative complications. Results Totally 40 patients( 80. 0%,40/50) had total resection of the tumor,8( 16. 0%,8/50) had subtotal tumor resection and the other 2( 4. 0%,2/50)had major removal. The pituitary stalk and the gland were well identified and reserved. Temporary diabetes insipidus occurred in 8 patients( 16. 0%,8/50),no permanent urinal. There was significant improvement for hypopituitarism in all patients during the following-up from 3 to 12 months. Conclusion Accurate identification of the gland,the pituitary stalk and the abnormal tissue during the microscopic transsphenoidal operation plays a critical role in preserving the pituitary function.