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目的探讨巨大侵袭型垂体腺瘤经颅切除的显微手术策略和并发症防治。方法对46例巨大侵袭型垂体腺瘤患者,根据术前影像学资料选用不同的手术入路,术中经鞍区不同解剖腔隙显微镜下先行瘤内切除肿瘤,再分离视神经,注意保护鞍区的微血管。结果肿瘤全切除34例,次全切除12例。16例出现尿崩;10例出现下丘脑功能损伤表现;术中视神经均解剖保留,视力好转24例,无改善9例,加重10例。结论选择合理的手术入路是巨大垂体腺瘤手术成功的前提,熟练掌握鞍区的微血管解剖,娴熟的显微手术技术是避免术后并发症的关键。
Objective To investigate the microsurgical strategies and prevention and treatment of transcranial resection of giant invasive pituitary adenoma. Methods Forty-six patients with giant invasive pituitary adenoma were selected with different surgical approaches according to the preoperative imaging data. The tumor was excised by different anatomical lacuna microscopies in the first surgery, then the optic nerve was separated and the saddle area was protected Microvascular. Results Total resection of the tumor in 34 cases, subtotal resection in 12 cases. 16 cases of diabetes insipidus; 10 cases of hypothalamic functional injury performance; intraoperative optic nerve anatomical retention, visual acuity improved in 24 cases, 9 cases without improvement, increased in 10 cases. Conclusion Choosing a reasonable surgical approach is a prerequisite for the successful operation of giant pituitary adenoma. Proficiency in the anatomy of the capillaries in the saddle area and skillful microsurgical techniques are the keys to avoiding postoperative complications.