经蝶窦显微外科手术治疗开颅术后复发性垂体腺瘤

Transsphenoidal Re-operation for Residual and Recurrent Pituitary Adenomas after Craniotomy

目的 探讨开颅术后残留及复发性垂体腺瘤的再次经蝶窦手术。方法 男性7例,女性9例。平均年龄49.9岁。4例为开颅术后残留性垂体腺瘤。12例为开颅术后复发性垂体腺瘤,平均复发时间为3.9年。临床表现视功能障碍14例,头痛6例,垂体功能低下4例。肿瘤1～3cm者6例,3cm以上者10例。垂体无功能腺瘤12例,泌乳素腺瘤3例,生长激素腺瘤1例。均选择经口鼻蝶窦入路再次手术。结果 肿瘤全切除7例,大部分切除6例,部分切除3例。随诊6月～5年,15例病人肿瘤未复发。结论 经额开颅术后残留及复发性垂体腺瘤可选择经蝶窦入路再次手术。

Objective To discuss the transsphenoidal re-operations for residual and recurrent pituitary adenomas after the craniotomy. Methods Sixteen patients underwent the transsphenoidal re-operations for residual and recurrent pituitary adenomas after the craniotomy. Of the 16 patients, 4 had residual adenomas and 12 suffered from recurrent adenomas 3.9 years (on an average) after the first operation. There was visual impairment in 14 cases, headache in 6, hypopituitarism in 4. Tumor size was l-3cm in 6 cases and over 3cm in 10. Twelve patients had non-function pituitary adenomas, 3 prolactinomas and 1 growth hormone adenoma. Results Of the 16 cases, 7 received total removel of the tumor, 6 subtotal and 3 part. The fellow-up for 6 months to 5 years showed that the tumor did riot recur in 15 patients. Conclusion Transsphenoidal re-operations is the best surgical method for the residual and recurrent pituitary adenomas after the craniotomy.