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目的探讨大型垂体腺瘤显微手术治疗方法和疗效。方法回顾分析我院1998年9月～2008年9月间409例大型垂体腺瘤的临床资料。根据肿瘤的大小、生长方式、影像学特点,分别采用了经鼻腔-蝶窦入路221例(54.0%),经额下-翼点入路103例(25.2%),翼点入路25例(6.1%),扩大翼点入路18例(4.4%),眉弓外侧锁孔入路42例(10.27%)。其中分期行额下-翼点入路和经鼻腔-蝶窦入路6例(1.47%)。结果409例大型垂体腺瘤全切除125例(30.6%),次全切除230例(56.0%),部分切除54例54(13.2%)。死亡8例(2.0%)。结论据肿瘤的生长特点和病人具体情况选择适当的手术入路是提高肿瘤全切除率、降低死亡率、改善病人术后生存质量的重要手段。
Objective To investigate the microsurgical treatment of large pituitary adenomas and its efficacy. Methods The clinical data of 409 cases of large pituitary adenoma in our hospital from September 1998 to September 2008 were retrospectively analyzed. 221 cases (54.0%) underwent transnasal-sphenoid sinus approach, 103 cases (25.2%) through the frontal-wing point approach, 25 cases from the pterional point approach, according to tumor size, growth pattern and imaging features. (6.1%), enlarged pterional approach 18 cases (4.4%), keyhole lateral patellar approach 42 cases (10.27%). Among them, there were 6 cases (1.47%) under staging line-wing point approach and transnasal-sphenoid sinus approach. Results Of the 409 cases with large pituitary adenomas, 125 cases (30.6%) were removed completely, 230 cases (56.0%) underwent total subtotal resection and 54 (13.2%) cases were partially removed. 8 cases died (2.0%). Conclusion According to the characteristics of tumor growth and the specific conditions of patients, choosing the appropriate surgical approach is an important means to improve the total resection rate, reduce mortality and improve the quality of postoperative patients’ survival.