经蝶窦入路梨状孔扩大切除垂体大腺瘤

Transsphnoidal approach microsurgery through enlarged piriform aperture for pituitary macroadenomas

目的 探索经蝶窦入路切除垂体大腺瘤手术中梨状孔扩大的意义。 方法 1997年 3月～ 2 0 0 0年 10月 ,经蝶窦入路手术治疗 96例垂体大腺瘤 ,术中均采用扩大梨状孔的方法。 结果 全切除 6 5例 (6 7 7% ) ,大部分 (80 %～ 90 % )切除2 5例 (2 6 0 % ) ,部分 (<5 0 % )切除 6例 (6 3% )。术后短暂尿崩症 2 1例 (2 1 9% ) ,脑脊液漏 9例 (9 4 % )。随访 39例 (40 6 % ) ,时间 3月～ 5年 ,平均 2年 8月 ,复发 3例 (7 7% )。 结论 经蝶窦入路切除垂体大腺瘤安全有效。采用梨状孔扩大的方法可以增加手术显露范围 。

ObjectiveTo evaluate the significance of pirif orm aperture enlarge ment in transsphnoid approach microsurgery for pituitary macroadenomas.MethodsTranssphnoidal approach microsurgery through enlarged pyrifor m aperture was ca rried out in 96 patients with pituitary macroadenoma from March 1997 to October 2000.ResultsAmong the 96 patients, 65 (67 7%) underwent tot al removal of the tumor, 25 (26 0%) underwent subtotal removal (80%～90%), and 6 (6 3%) partial removal (<50%). P ostoperative complications included temporary diabetes insipidus in 21 cases (21 .9%) and cerebrospinal fluid rhinorrhea in 9 cases (9 4%). Follow-up for 3 mont hs～ 5 years (mean, 2 years and 8 months) showed recurrence in 3 cases (7 7%). ConclusionsTranssphnoid approach microsurgery for pituitary macr oadenomas is safe a nd effective. Piriform aperture enlargement may offer a better exposure of opera tion field and benefit the safe removal of tumor.