显微镜下经鼻蝶入路手术切除垂体腺瘤115例

Clinical observation of the pituitary adenoma resection by nasal transsphenoidal approach under microscope in 115 cases

目的：观察显微镜下经鼻蝶入路手术切除垂体腺瘤的临床疗效及安全性。方法：显微镜下经鼻蝶入路手术切除垂体腺瘤115例，对瘤体大小、内分泌类型、肿瘤切除范围等与临床效果的关系，并对术后并发症的影响因素进行分析。结果：术后随访1~2年，治愈81例，缓解未复发20例，复发12例，病死2例；微腺瘤的治愈率均高于大腺瘤和巨大腺瘤（P〈0.05）；促肾上腺皮质激素腺瘤、生长激素腺瘤和混合腺瘤的治愈率均高于无功能腺瘤的治愈率（P〈0.05）；全切和次全切的治愈率均高于部分切除患者的治愈率（P〈0.05）；具有基础内分泌功能性腺瘤是术后发生并发症明显低于非功能性腺瘤（P〈0.01）。结论：经鼻蝶入路垂体腺瘤切除术治疗垂体腺瘤临床效果好，其临床疗效与肿瘤的大小、功能类别、切除范围有关。

Objective：To observe the clinical effects and safety of the pituitary adenoma resection by nasal transsphenoidal approach under microscope. Methods：The pituitary adenomas in 115 patients were resected by nasal transsphenoidal approach under microscope. The relationships between the size, endocrine type, resection range of the tumor and clinical effects, and the influence factors of the postoperative complications were retrospectively analyzed. Results：All patients were followed up for 1 to 2 years,81 cases were cured, 20 cases were eased,12 cases recurred and 2 cases died. The cure rate of microadenoma was higher than that in large adenoma and huge adenoma（P〈0. 05）. The cure rates of PRL adenoma,adrenocorticotropic hormone adenoma,growth hormone adenoma and mixed adenoma were higher than that in non-function adenoma（P〈0. 05）. The cure rates in patients treated with total and subtotal excision were higher than that in patients with partial excision（P〈0. 05）. The complications recurrence of the functional pituitary adenoma was sighificantly lower than that of the non functional pituitary adenoma. Conclusions：The clinical effects of the pituitary adenoma resection by nasal transsphenoidal approach are good,which are related to the size,functional type and excision range of tumor.