垂体腺瘤患者经蝶术后急性视功能障碍的原因和防治

Causes and treatment of acute visual dysfunction after transsphenoidal surgery of pituitary adenoma

目的 探讨经蝶垂体腺瘤术后早期继发急性视功能障碍的原因及其防治措施.方法 回顾性分析北京协和医院1991年1月至2014年5月经蝶垂体腺瘤切除术后早期发生急性视功能障碍的12例患者的临床资料.结果 12例中8例鞍内出血,2例鞍上出血,2例血管痉挛.治疗后视功能恢复良好10例,1例合并颅内动脉瘤破裂恢复欠佳,1例鞍上出血死亡.结论 视神经和视交叉长期受到垂体腺瘤压迫而导致血运变差,在此基础上,合并了继发鞍内血肿、手术直接损伤、急性视神经缺血、鞍内填塞过紧等因素,从而导致垂体腺瘤经蝶术后继发急性视功能障碍,及时发现和明确病因并早期治疗可以有效挽救患者视力.

Objective Visual dysfunction is a sever complication of transsphenoidal surgery of pituitary adenoma.In this study,we explored the mechanisms and strategies of prevention and treatment of early acute visual deterioration after transsphenoidal surgery for removal of pituitary adenoma.Methods Clinical data of 12 patients with transsphenoidal pituitary adenoma resection of early postoperative acute visual deterioration were analyzed retrospectively.All the cases were come from Peking Union Medical College Hospital during Jan 1991 to May 2014.Results Among 12 cases,8 were with intrasellar haematoma,2 with suprasellar haematoma,2 with vascular spasm.After all these treatments,good recovery achieved in 10 cases,not so well in 1 with rupture of intracranial aneurysm,and 1 case death with suprasellar haematoma and intracranial infection.Conclusions Blood circulation variation of the optic nerve and optic chiasma could be caused by long-term compressing with thepituitary adenoma,on this basis,combined with the intrasellar haematoma,direct injury during the operation,and acuteischemia of the optic chiasma andtamping too tight in the sella turcica,etc,resulting in acute visual function disorder after pituitary adenomas transsphenoidal surgery,find the reason and early treatment can be effective to save the patient＇s visual acuity.