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目的探讨经单鼻孔蝶窦入路显微手术切除老年人垂体腺瘤的手术方法和疗效以及并发症的围手术期处理。方法回顾性分析我科在1995年1月～2005年12月采用本法治疗老年人垂体腺瘤54例,其中大腺瘤23例,巨大腺瘤31例。31例伴有垂体功能低下,经病理和内分泌学检查证实垂体PRL腺瘤18例,GH腺瘤5例,ACTH腺瘤7例,多分泌功能细胞腺瘤3例,无功能腺瘤21例。结果本组肿瘤全切除23例,次全切除20例,大部分切除11例。随访0．5～7．5年,治愈27例,缓解21例,复发3例,死亡1例,失访2例。结论本手术方法能最大限度地保护脑功能、创伤小、手术并发症少、术后恢复快、住院时间短,特别适宜治疗老年人垂体腺瘤。
Objective To investigate the surgical method and efficacy of pituitary adenoma resection in elderly patients via single nostril sphenoid sinus approach and the perioperative management of complications. Methods A retrospective analysis of our department in the period from January 1995 to December 2005 used this method to treat 54 cases of pituitary adenomas in the elderly, including 23 cases of large adenomas and 31 cases of giant adenomas. Thirty-one patients were associated with hypopituitarism. Eighteen cases of pituitary PRL adenomas, five cases of GH adenomas, seven cases of ACTH adenomas, three cases of multiple secretory cell adenomas, and 21 cases of nonfunctioning adenomas were confirmed by pathological and endocrinological examinations. Results In this group, there were 23 cases of total tumor resection, subtotal resection of 20 cases, and most of resection of 11 cases. After 0.5 to 7.5 years of follow-up, 27 cases were cured, 21 eased, 3 recurred, 1 died, and 2 lost. Conclusion This surgical method can protect brain function, minimal trauma, fewer operative complications, rapid postoperative recovery, and short hospital stay. It is particularly suitable for the treatment of pituitary adenoma in the elderly.