经额底纵裂入路切除侵袭性垂体腺瘤的临床分析

Clinical analysis of removal of invasive pituitary adenoma via frontobasal interhemispheric approach

目的探讨经额底纵裂入路切除侵袭性垂体腺瘤的疗效。方法回顾性分析29例侵袭性垂体腺瘤病人的临床资料,经额底纵裂入路手术切除肿瘤。结果肿瘤全切除7例,近全切除14例,大部分切除8例。病理检查示:两种及以上激素腺瘤11例,无功能腺瘤9例,泌乳素腺瘤3例,促肾上腺皮质激素腺瘤3例,生长激素腺瘤、促甲状腺激素腺瘤、生殖细胞瘤(术前误诊为垂体腺瘤)各1例。手术并发症包括垂体功能低下10例,短暂电解质紊乱15例,一过性尿崩5例,颅内感染2例,短暂动眼神经麻痹1例,视力恶化1例,术区血肿1例。随访24例,时间3个月～2年,复发11例。结论采用经额底纵裂入路切除侵袭性垂体腺瘤,手术暴露空间好,可使病人获得良好的治疗效果。

Objective To explore the therapeutic effect of surgery for invasive pituitary adenoma via frontobasal interhemispheric approach.Methods Clinical data of 29 patients with invasive pituitary adenomas were analyzed retrospectively,and the tumors were resected by surgery via frontobasal interhemispheric approach.Results Complete tumor resection was achieved in 7 patients,subtotal in 14 and partial in 8.The pathology results were as follows:bi-hormone and multi-hormone adenomas in 11 patients,non-functioning adenomas in 9,prolactinomas in 3 and adrenocorticotropic hormone adenomas in 3,growth hormone adenoma in 1,thyroid stimulating hormone adenoma in 1 and germinoma(preoperation misdiagnosis as pituitary adenoma)in 1.The postoperative complication s included hypopituitarism of 10 patients,transient electrolyte disorder in 15 and transient diabetes insipidus in 5,intracranial infection in 2,and transient oculomotor nerve palsy,vision deterioration,and hematoma in the operative region in 1 respecticely.Twenty-four patients were followed up for 3 months to 2 years,tumor relapse occurred in 11 patients.Conclusions The surgery for the invasive pituitary adenoma via frontobasal interhemispheric approach has a good space and the patients can obtain good therapeutic effect.