经鼻蝶窦入路垂体腺瘤切除术的疗效及术后并发症的防治

Treatment effect of excision via transoral-nosal-sphenoidal approach on pituitary adenoma and management of postoperative complications

目的探讨经蝶窦入路垂体腺瘤显微切除术的疗效及术后并发症的防治。方法云南省第一人民医院神经外科自2010年1月至2014年12月采用经鼻蝶窦入路显微切除术治疗垂体腺瘤患者104例。回顾性分析患者的临床资料和疗效，总结术后并发症的防治经验。结果本组肿瘤全切82例（78．8％1，次全切22例；术后视力改善42例，改善率为80．7％；术后激素水平完全恢复至正常34例（44．7％），激素水平较术前下降但仍高于正常值上限者38例（50．0％）。术后主要并发症为尿崩、脑脊液鼻漏、电解质紊乱、垂体功能低下、术区出血等，经积极治疗后均得到不同程度的改善．总体疗效良好。结论经鼻蝶窦入路显微镜下垂体腺瘤切除术是治疗垂体腺瘤的良好路径．减少手术并发症的关键是良好的显微外科操作技术。

Objective To investigate the treatment effect of excision via transoral-nosal-sphenoidal approach on pituitary adenoma and management of postoperative complications. Methods One hundred and four pituitary adenoma patients, admitted to our hospital from January 2010 to December 2014 and microsurgically treated via transoral-nosal-sphenoidal approach, were chosen in our study. The clinical data of these patients and microsurgical treatment efficacy were analyzed retrospectively and postoperative complications were concluded. Results Total resection was observed in 82 patients （78.8%） and subtotal resection in 22 （21.2%）. Forty-two patients got vision improvement with an improvement rate of 80.7%. Hormonal readiness recovered to normal level in 34 patients （44.7%）; hormonal readiness being decreased but still higher than normal level was noted in 38 （50.0%）. The major postoperative complications included diabetes insipidus, cerebrospinal fluid rhinorrhea, electrolyte disturbance, hypopituitarism and hemorrhage. The symptoms and signs of patients were improved in varied degrees, and the postoperative complications were controlled. Conclusions The transoral-nosal-sphenoidal approach is an ideal method to resect pituitary adenoma and active management of postoperative complications is essential to the prognosis of patients.