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目的总结巨大垂体腺瘤显微手术的各种方法、治疗效果,分析术后并发症的发生原因,探讨预防措施。方法回顾性分析了1981-12～2000-12经CT、MRI及内分泌检查确诊的巨大型垂体腺瘤206例;其中A组83例单纯经翼点入路开颅切除肿瘤,B组97例单纯经鼻前庭-鼻中隔-蝶窦(以下简称“经鼻蝶”)入路切除肿瘤,C组26例联合应用以上两种方法分期、分次切除肿瘤。结果全切或次全切A、B、C组分别为42例(占50.6%),21例(占21.6%),24例(占92.3%);死亡数三组依次为2例(占2.4%),1例(占1.03%),0;尿崩三组分别为51例(占61.4%),18例(占18.6%),11例(占42.3%);下丘脑受损三组依次为26例(占31.3%),2例(占2.1%),0;脑脊液鼻漏三组依次为0,27例(占27.8%),8例(占30.8%)。三组全切率、尿崩率比较,有非常显著差异(P<0.01)。结论在严格掌握经翼点及经鼻蝶入路手术适应证的情况下,取两者各自的优点,对巨大型垂体腺瘤行分期、分次切除是一种提高全切率、降低死亡率和复发率、减少并发症的安全、有效的治疗方法。
Objective To summarize various methods and treatment effects of microsurgical operation for giant pituitary adenomas, analyze the causes of postoperative complications and discuss the preventive measures. Methods A retrospective analysis of 206 cases of giant pituitary adenomas diagnosed by CT, MRI and endocrine examination from December 1981 to December 2000 was performed. Among them, 83 cases in group A underwent craniotomy with pterional approach only, and 97 cases in group B The nasal vestibule - nasal septum - sphenoid sinus (hereinafter referred to as “transnasal”) approach to remove the tumor, C group of 26 patients combined with the above two methods staging, sub-total removal of the tumor. Results The results of total or subtotal resection were 42 cases (50.6%) in group A, B and C, 21 cases (21.6%) and 24 cases (92.3% There were 51 cases (61.4%), 18 cases (18.6%) and 11 cases (42.3%) in the three groups of diabetes insipidus, respectively. The hypothalamus was damaged in three groups 26 cases (31.3%), 2 cases (2.1%), 0; cerebrospinal fluid rhinorrhea three groups followed by 0,27 cases (27.8%), 8 cases (30.8%). There was a significant difference between the three groups in total cut rate and the rate of urinary collapse (P <0.01). Conclusion Strictly grasp the pterygium via transnasal approach indications, taking the respective advantages of both, the huge pituitary adenoma staging, graded excision is an increase of full-cut, reduce mortality And relapse rate, reduce the complications of the safe and effective treatment.