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目的 介绍经额外侧入路及显微手术技术切除 1例颅咽管瘤 ,2 0例大型、巨大型垂体腺瘤的经验。方法 所有病人均采用经额外侧入路。垂体腺瘤切除的要点 :①先切除鞍内鞍上的大部分肿瘤 ;②电灼并切断来自视神经、视交叉、颈内动脉及硬脑膜等处的肿瘤新生血管 ,切断一切供瘤及引流血管 ;③分片切除鞍上的瘤壁 ,电灼鞍内的瘤壁 ,同时全切残余的肿瘤 ;④保护好垂体柄。结果 1例颅咽瘤壁 ,予以全切 ;2例大型、巨大型垂体腺瘤为次全切 ,其余为全切。本组无死亡及重残病例 ,所有病人术后情况良好 ,生活如常。结论 位于鞍区的肿瘤直径在 52mm以内 ,是可以经额外侧入路 ,采用显微手术 ,安全全切的。
Objective To introduce the experience of removing one case of craniopharyngioma and 20 cases of large and huge pituitary adenoma by extra lateral approach and microsurgical technique. Methods All patients underwent additional lateral approach. The main points of resection of pituitary adenomas: ① first remove most of the saddle on the saddle; ② electrocautery and cut off from the optic nerve, optic chiasm, internal carotid artery and dura tumor neovascularization, cut off all for tumor and drainage of blood vessels ; ③ fragment removal of the saddle on the wall of the tumor, the wall of the saddle within the electric shock, while removing residual tumor; ④ protect the pituitary stalk. Results 1 case of craniopharyngioma wall, to be fully cut; 2 cases of large, huge pituitary adenomas subtotal incision, the rest for the whole cut. No deaths and severe disability in this group of patients, all patients in good condition, life as usual. Conclusion The diameter of the tumor located in the saddle area is less than 52 mm. It can be surgically removed by extra-lateral approach and microsurgery.