单鼻孔经蝶切除垂体微腺瘤的选择与技巧

Surgical choice and skills of pituitary microadenoma resection via single nostril transsphenoidal approach

目的探讨经蝶入路切除垂体微腺瘤的手术选择及技巧。方法回顾性分析经蝶入路显微手术治疗的30例垂体微腺瘤病人的临床资料,手术力争肿瘤包膜外切除,必要时适度电凝瘤床。免疫组化分型:泌乳素腺瘤8例,促肾上腺皮质激素(ACTH)腺瘤7例,生长激素腺瘤5例,促甲状腺激素(TSH)腺瘤1例,多分泌功能腺瘤5例,无功能腺瘤4例。结果手术全切肿瘤28例,次全切除2例(生长激素腺瘤和ACTH腺瘤各1例)。术后4个月,23例激素水平降至正常,2例下降大于50%,1例无明显变化。随访30例,时间6~78个月。临床症状均有不同程度改善。结论症状性无功能垂体微腺瘤可行经蝶手术治疗,功能性微腺瘤经蝶手术确切有效。术中精确定位与显露肿瘤以及熟练处理海绵间窦出血,是全切除垂体微腺瘤的重要前提。

Objective To explore the surgical choice and skills of pituitary microadenoma resection via single nostril transsphcnoidal approach. Methods Clinical data of 30 patients with pituitary microadenoma were analyzed retrospectively who underwent surgical resection via single nostril transsphenoidal approach. The resection was performed as extracapusularly as possible and tumor beds were treated moderately by electrocoagulation if necessary. The immunohistochemical examination revealed that there was prolactin adenoma in 8 patietns, adrenocorticotropic hormone （ACTH） adenoma in 7, growth hormone （GH） adenoma in 5, thyroid stimulating hormone （TSH） adenoma in 1, plurihormone-secreting adenoma in 5 and nonfunctioning adenoma in 4. Results Total resection was achieved in 28 patients, subtotal resection in 2 including 1 ACTH adenoma and 1 GH adenoma. All the patients were followed up for 4 months, hormone levels decreased to normal level in 23 patients, decreased more than 50% in 2 and remained unchanged in 1. Thirty patients were followed up for 6 to 78 months and clinical symptoms were all improved to different degrees. Conclusions Symptomatic non-fimctional pituitary microadenoma can be treated by transsphenoidal surgery. Transsphenoidal surgery is effective for functional pituitary microadenoma. Accurate location and exposure of the tumor during operation and skillfull treatment of cavernous sinus hemorrhage are important prerequisites for total resection of pituitary microadenoma.