经蝶窦显微手术切除侵袭海绵窦的垂体腺瘤

Resection of pituitary adenoma invading the cavernous sinus by transsphenoidal microsurgery

目的 探讨经蝶窦显微手术切除侵袭海绵窦的垂体腺瘤的手术适应证和手术技巧。 方法 42例侵袭海绵窦的垂体腺瘤病例均采用经口 鼻 蝶窦入路 ,共进行 45次手术。术中在C 臂X线机或神经导航监测下尽可能开大侧方鞍底 ,显微放大下切开鞍底硬膜。依肿瘤侵袭的方向、通道按不同次序分块切除肿瘤。少量残留的病例加用溴隐亭治疗 ,溴隐亭治疗无效及部分残留病例加用放射治疗。 结果 无手术死亡 ,近全切除 2 1例 ,次全切除 18例 ,部分切除 3例。术后 2～ 3月复查MRI ,影像学肿瘤消失 19例 ,少量残留 2 0例 ,部分残留 3例。 结论 该类肿瘤伴蝶鞍扩大、术前MRI检查提示质地软 ,可经蝶窦手术 ,采用显微手术有助于肿瘤全切除及对鞍隔。

Objective To study the criteria and technique of transsphenoidal microsurgery on pituitary adenoma invaded cavernous sinus Methods 42 patients with pituitary adenoma underwent 45 transsphenoidal operations Sellar base was opened as large as possible under C arm X ray fluoroscopy or neuronavigation monition Dura matter was cut open under microscope Tumors were removed through the direction and tunnel they in invade Bromocriptine was administered to those with little remains Partial remains and those have no response to bromocriptine were given radiotherapy Results No modality 21 tumors were nearly totally removed, 18 tumors were subtotally resected, 3 were partially resected MRI scanned in 2～3 months after the operation showed that 19 tumors disappeared, 20 tumors had little residul, 3 tumors partially remained Conclusion Pituitary adenomas invading the cavernous sinus with enlarged sella turcica and shown soft in MRI can be submitted to transsphenoidal operation Microsurgical technique can ease tumor removal and protection of the sellar and internal carotid artery