论文部分内容阅读
目的总结经单鼻孔-蝶窦显微切除垂体腺瘤的手术体会与疗效。方法回顾性分析92例经单鼻孔-蝶窦入路显微手术切除鞍区病变患者临床资料。垂体微腺瘤12例,大型垂体腺瘤47例,巨大型及复发性垂体腺瘤24例,垂体囊肿5例,垂体脓肿2例,颅咽管瘤2例。结果术后早期(1周内)复查的CT或MR,垂体微腺瘤、垂体囊肿、垂体脓肿、颅咽管瘤全切除率达98%,大型垂体腺瘤全切除率达80·9%,巨大或复发性腺瘤全切除率达62·5%。术后短暂尿崩5例,脑脊液漏2例,经治疗全部治愈。无颅内感染、视神经损伤等。术后月经恢复,性功能改善占82%,8例要求生育者有6例术后1~9个月怀孕;视力改善占90%;60%垂体内分泌激素恢复正常。结论经单鼻孔-蝶窦显微切除垂体腺瘤(必要时辅以内窥镜)是一种理想的治疗方法,对于中小型腺瘤,可根据术者的经验及习惯采用内窥镜手术或者显微手术,对于巨、大伴有广泛侵袭扩展、质地坚韧,血供丰富的肿瘤应以显微手术方法为主,这样可以充分发挥神经外科医生的显微手术技巧。具有损伤少、肿瘤全切除率高,术后恢复快,合并症少,生活质量高的优点。
Objective To summarize the surgical experience and curative effect of microsurgical excision of pituitary adenoma via single nostril - sphenoid sinus. Methods The clinical data of 92 patients who underwent microsurgery of the sellar region by single nostril transsphenoidal approach were retrospectively analyzed. 12 cases of pituitary adenoma, 47 cases of large pituitary adenoma, 24 cases of giant and recurrent pituitary adenoma, 5 cases of pituitary cyst, 2 cases of pituitary abscess and 2 cases of craniopharyngioma. Results The total resection rate of CT or MR, pituitary adenoma, pituitary cyst, pituitary abscess and craniopharyngioma in the early postoperative period was 98%, and the rate of total pituitary adenomas was 80.9% The total resection rate of giant or recurrent adenoma was 62.5%. Postoperative short-term diabetes insipidus in 5 cases, 2 cases of cerebrospinal fluid leakage, all cured by treatment. No intracranial infection, optic nerve injury and so on. Postoperative menstrual recovery, sexual function improvement accounted for 82%, 8 cases required births 6 cases 1 to 9 months after the pregnancy; visual improvement 90%; 60% pituitary hormone returned to normal. Conclusions Microsurgery of pituitary adenomas (with endoscopy when necessary) is an ideal treatment for small and medium adenomas. Endoscopic surgery or microsurgery can be performed according to the surgeon’s experience and habits , For the giant, large with extensive invasion and expansion, tough texture, rich in blood supply should be based on microsurgical methods, which can give full play to the neurosurgical microsurgery skills. With less damage, tumor removal rate, postoperative recovery fast, less complications, high quality of life advantages.