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本文报告经筛、蝶窦手术治疗垂体腺瘤64例。其中泌乳素腺瘤占43.75%,生长激素腺瘤占21.87%,肾上腺皮质激素腺瘤占7.81%,非分泌性腺瘤占9.3%。47例患者有视力障碍,51例有视野缺损。泌乳激素腺瘤临床表现为闭经、溢乳及不孕,生长激素腺瘤表现为肢端肥大症,肾上腺皮质素瘤表现为 Cushing 综合征或 Nelson 综合征。应用经筛手术切除肿瘤,术后临床表现改善占94.91%,视力改进占89.36%,视野改进占90.19%。术后激素水平恢复正常者占30.36%,降低2/3者占44.64%,降低1/3者占14.29%。微腺瘤术后61.54%激素恢复正常,大型腺瘤仅为32.2%,手术死亡率为1.56%。最后对本文术式的优点及注意事项结合文献进行了讨论。
This article reports 64 cases of pituitary adenoma treated with sphenoid sinus surgery. Prolactin adenomas accounted for 43.75%, growth hormone adenomas accounted for 21.87%, adrenocortical hormone adenomas accounted for 7.81%, and non-secretory adenomas accounted for 9.3%. Forty-seven patients had visual impairment and 51 had visual field defects. Prolactin adenomas have clinical manifestations of amenorrhea, galactorrhea, and infertility. Growth hormone adenomas present with acromegaly and adrenal cortical tumors with Cushing syndrome or Nelson syndrome. The use of screening surgery to remove the tumor, postoperative clinical improvement accounted for 94.91%, visual improvement was 89.36%, visual field improvement accounted for 90.19%. Postoperative hormone levels returned to normal accounted for 30.36%, 2/3 decreased by 44.64%, and 1/3 decreased by 14.29%. 61.54% of hormones returned to normal after microadenomas, 32.2% of large adenomas and 1.56% of operative mortality. Finally, the advantages and precautions of this article are discussed in conjunction with the literature.