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目的 探讨不同手术入路切除垂体肿瘤优缺点。方法 95例垂体肿瘤选择不同手术入路 :经额下入路 73例 ;经额颞入路和翼点入路 10例 ;经蝶入路 7例 ;经双额前颅窝扩展入路和额眶蝶联合入路 5例。结合文献对各种手术入路进行回顾性分析。术后对病人分 0 .5、1、3、5年不同时间随访以确定疗效。结果 经额下入路 73例 ,全切除 2 8例 (38.36 % ) ,大部分和部分切除 45例 (6 1.6 4% ) ,死亡 3例 ,复发 16例。经额颞入路和翼点入路 10例 ,全切除 4例 (40 % ) ,大部分切除 6例 (6 0 % ) ,死亡 1例 ,复发 1例。经蝶入路 7例 ,全切除 3例 (42 .86 % ) ,大部分切除 4例 (5 7.14% ) ,死亡 1例 (鼻漏术后继发颅内感染 ) ,复发 1例。经双额前颅窝扩展入路和额眶蝶入路 5例 ,全切除 3例 (6 0 % ) ,大部分切除 2例 (40 % ) ,无死亡及复发。结论 垂体肿瘤手术时 ,一般采用经蝶显微外科手术入路 ,创伤小、恢复快、效果好 ;垂体肿瘤向鞍旁一侧生长时应选择额颞及翼点入路 ;对巨大或侵袭性垂体腺瘤适宜经双额前颅窝扩展入路和额眶蝶联合入路 ,该入路视野宽阔 ,全切除率高 ,复发及死亡率低 ;经额下入路手术视野小 ,全切除率低 ,易复发。
Objective To investigate the advantages and disadvantages of different surgical approaches to remove pituitary tumors. Methods Ninety-five cases of pituitary tumors underwent different surgical approaches: 73 under the frontal approach, 10 under the frontotemporal approach and pterional approach, 7 under the transsphenoidal approach, 5 cases of combined orbital butterfly approach. Combined with the literature on a variety of surgical approaches for retrospective analysis. Postoperative patients were 0.5, 1, 3, 5 years follow-up to determine the efficacy. Results Of the 73 cases underwent frontal resection, 28 cases (38.36%) were resected completely, 45 cases (6 1.6%) were mostly and partially resected, 3 cases died, and 16 cases recurred. Ten patients underwent frontotemporal approach and pterional approach, 4 cases (40%) underwent total resection, 6 cases (60%) underwent resection, 1 case died and 1 case recurred. In the transsphenoidal approach, 7 cases were removed, 3 cases (42.86%) underwent total resection, 4 cases (5 7.14%) were mostly resected, 1 died (secondary to intracranial infection after rhinorrhea) and 1 case recurred. Five patients underwent anterior extension of the anterior cranial fossa and frontal orbital approach. Three cases (60%) underwent total resection and two cases (40%) underwent resection, with no death or recurrence. Conclusion pituitary tumor surgery, the general adoption of transsphenoidal microsurgery approach trauma, rapid recovery, the effect is good; pituitary tumors to the side of the side of the parasellar should be selected frontotemporal and pterional approach; on the huge or invasive Pituitary adenoma is suitable for the expansion of the anterior approach of the anterior cranial fossa and the combined approach of the orbital butterfly. The wide field of vision, high total resection rate and low recurrence and mortality rate; Low, easy to relapse.