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目的 报告 32例大型及巨大型垂体腺瘤手术治疗经验。方法 2 0例经额下入路手术 ,9例经翼点入路手术 ,3例经终板入路手术。结果 全切除 2 1例 (66% ) ,次全切除 1 1例 (34% )。术后并发暂时性尿崩 1 4例 ,并发非酮症高渗性昏迷 1例 ,并发垂体功能低下 3例。均无脑脊液漏及颅内感染。术后 2 7例恢复工作 ,4例生活自理 ,1例死亡(3.1 % )。结论 术前最佳手术入路的选择 ;术中显微镜下对颅底动脉环及其重要穿通支 ,垂体上动脉 ,垂体柄 ,下丘脑的保护 ;术后积极处理并发症是手术治疗成功的关键。
Objective To report 32 cases of large and huge pituitary adenoma surgical treatment experience. Methods 20 patients underwent frontal surgery, 9 underwent pterional approach and 3 underwent endoscopic approach. Results Total resection 21 cases (66%), subtotal resection 11 cases (34%). Postoperative transient diabetes insipidus in 14 cases, complicated by non-ketotic hyperosmolar coma in 1 case, complicated by pituitary dysfunction in 3 cases. No cerebrospinal fluid leakage and intracranial infection. After operation, 27 patients recovered, 4 patients took care of themselves and 1 died (3.1%). Conclusion The best preoperative surgical approach choice; under the microscope under the skull base arterial ring and its important perforating branch, the pituitary artery, pituitary stalk, hypothalamus protection; postoperative aggressive management of complications is the key to the success of surgical treatment .