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目的探讨巨大型垂体腺瘤显微手术切除及垂体柄保护方法。方法采用改良翼点入路对48例巨大垂体腺瘤(直径>40mm)行显微手术切除,术中注意保护垂体柄。结果肿瘤全切除36例,近全切除8例,大部切除4例,其中全切除患者垂体柄保留30例(83.3%)。所有病例无一例死亡。术后发生尿崩症31例(64.6%),其中21例在1～2周内恢复正常,7例在3个月内恢复,3例尿崩症状持续2年左右。随访2～3年,无复发病例,无其他并发症。结论采用改良翼点入路治疗巨大垂体瘤效果确切,术中垂体柄保留是降低术后尿崩症发生率、提高手术疗效的关键措施。
Objective To investigate the microsurgical removal of giant pituitary adenomas and the protection of pituitary stalk. Methods Forty - eight cases of giant pituitary adenoma (diameter> 40mm) underwent microsurgical resection with modified pterional approach. The pituitary stalk was protected during operation. Results Total resection in 36 cases, nearly total resection in 8 cases, the majority of resection in 4 cases, including total resection of the pituitary stalk in 30 cases (83.3%). None of the deaths occurred in all cases. Postoperative diabetes insipidus occurred in 31 cases (64.6%), of which 21 cases returned to normal in 1 to 2 weeks, 7 cases recovered within 3 months, 3 cases of diabetes insipidus symptoms lasted 2 years. Follow-up 2 to 3 years, no recurrence, no other complications. Conclusion The modified pterional approach for the treatment of giant pituitary tumors is exact. Intraoperative pituitary stalk preservation is the key measure to reduce the incidence of postoperative diabetes insipidus and improve the curative effect.