蝶窦入路切除垂体腺瘤后患者视力障碍恶化的原因及防治

Vision deterioration after transsphenoidal surgery for removal of pituitary adenoma

目的 探讨经蝶窦入路切除垂体腺瘤后视力障碍恶化的原因和防治方法。 方法 对采用经蝶窦入路切除垂体腺瘤 ,术后出现视力障碍恶化的 14例患者的临床资料 (病史、临床表现、影像学结果及手术所见 )进行回顾分析。 结果 本组患者出现视力障碍恶化的原因 ,5例为瘤床填放物过多、3例为残瘤卒中、2例可能为血管痉挛、2例为颅内压增高、1例为视神经管内视神经受损、1例原因不明。 结论 经蝶窦入路切除垂体腺瘤 ,术后患者视力障碍恶化是垂体腺瘤手术的严重并发症 ,及时发现和早期治疗可以显著改善患者视力。

Objective To explore the mechanism and strategies of prevention and treatment of vision deterioration after transsphenoidal surgery for removal of pituitary adenoma. Methods From Jannuary 1980 to February 2001, 1 412 patients were operated on by transsphenoidal surgery to remove pituitary adenoma. Fourteen patients experienced vision deterioration after operation. Clinical data from the 14 patients with vision deterioration were analyzed retrospectively. Results In this group, the incidence of vision deterioration was 0 99%. Over packing of the adenoma bed was seen in 5 patients, apoplexy of residual tumor in 3, high intracranial pressure in 2, vascular spasm in 2, injury of the optic nerve in the cannel in 1 and unknown reason in 1. Conclusions Vision deterioration is a severe complication after transsphenoidal surgery. Early diagnosis and treatment can greatly improve the vision.