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目的探讨经鼻蝶显微手术治疗复发性垂体腺瘤的疗效、手术技巧及并发症处理。方法选择26例复发性垂体腺瘤患者,其中男性11例,女性15例;年龄18~74岁,平均年龄51.3岁。全部患者行手术治疗,对手术前后临床症状改善情况、并发症出现情况进行分析。结果手术全切及次全切13例(50%),术前主要症状视力下降、视野缺损、头痛,术后改善率分别为76.2%、75.0%、75.0%。术后并发症为视力下降5例,脑脊液鼻漏2例,术后感染1例,术后出血2例,尿崩症状6例,术后出现新的激素水平异常3例。结论复发性垂体腺瘤再次手术并发症较初次手术高;术中仔细操作,术后积极预防并发症能使患者获益;经鼻蝶显微手术治疗复发性垂体腺瘤安全、有效。
Objective To investigate the efficacy, surgical skills and complications of transnasal butterfly microsurgery for recurrent pituitary adenoma. Methods Twenty-six patients with recurrent pituitary adenoma were selected, including 11 males and 15 females, aged 18-74 years, with an average age of 51.3 years. All patients underwent surgical treatment, before and after surgery to improve the clinical symptoms, complications were analyzed. Results The total and subtotal resections were performed in 13 cases (50%). The preoperative visual acuity, visual field defect, headache and postoperative improvement were 76.2%, 75.0% and 75.0% respectively. Postoperative complications were 5 cases of decreased visual acuity, 2 cases of cerebrospinal fluid rhinorrhea, 1 case of postoperative infection, 2 cases of postoperative bleeding, 6 cases of diabetes insipidus symptoms, and 3 cases of new hormonal abnormalities after operation. Conclusions The complications of reoperation of pituitary adenomas are higher than those of the first operation. Careful operation during operation and active prevention of postoperative complications can benefit the patients. Transnasal butterfly microsurgery is a safe and effective method for the treatment of recurrent pituitary adenomas.