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目的探讨经翼点入路显微手术切除鞍区肿瘤的方法及临床效果。方法对2000年1月至2012年2月收治的66例经翼点入路显微手术切除鞍区肿瘤患者进行回顾性分析总结。结果 66例患者,肿瘤全切55例,次全切8例,大部切除3例。术后病理检查,垂体瘤38例,颅咽管瘤16例,脑膜瘤12例;术后32例发生尿崩,18例出现低钠血症,3例高钠血症,无手术死亡病例。54例患者随访6个月至5年,术前视力下降45例,术后视力恢复好转38例,无变化5例,恶化2例。肿瘤残留11例,术后行γ刀放疗6例,肿瘤复发3例,1例鞍区并发眶内脑膜瘤。结论在经翼点入路行鞍区肿瘤显微手术中,熟练掌握规范的手术入路和局部显微解剖以及良好的显微外科技术是提高肿瘤全切率和手术疗效的保证。
Objective To study the method and clinical effect of microsurgical removal of sellar tumors by pterional approach. Methods From January 2000 to February 2012, 66 patients with microscopic resection of sellar tumors by pterional approach were retrospectively analyzed. Results In the 66 cases, 55 cases were completely resected, 8 cases were subtotally resected and 3 cases were resected. Postoperative pathological examination, 38 cases of pituitary tumor, craniopharyngioma in 16 cases, meningioma in 12 cases; 32 cases of postoperative diabetes insipidus, 18 cases of hyponatremia, 3 cases of hypernatremia, no surgical deaths. 54 patients were followed up for 6 months to 5 years, 45 cases of preoperative visual acuity decreased, visual acuity improved in 38 cases, no change in 5 cases, 2 cases of deterioration. Tumor residual in 11 cases, postoperative gamma knife radiotherapy in 6 cases, 3 cases of tumor recurrence, 1 case of orbital septal meningioma. Conclusions During the microsurgery of the sellar region via the pterional approach, the mastery of standardized surgical approach and local microsurgical dissection as well as the good microsurgical techniques are the guarantees of improving the rate of complete tumor resection and surgical treatment.