大型垂体腺瘤经蝶显微外科切除技术

为探讨大型垂体腺瘤（LPA）经蝶入路、应用显微外科手术治疗的效果,作者对1520例LPA以颅骨X线平片、CT或MRI等影像学检查做出诊断,采取经蝶入路、显微镜下进行肿瘤切除术的病例进行了回顾性分析,结果表明,1264例（83.2%)获全切除,195例（12.8%)达次全切除,余61例（4.0%)系哑铃型或纤维性腺瘤,仅获部分切除。手术后2例（0.1%)死亡。1240例进行平均3.5年随访观察、有1219例（98.3%)视力损害获得了恢复,仅21例（1。7％）,但未见恶化;术前有视野缺损的1226例,术后1186例（96.7%)明显改善,40例（3.3%)无变化,作者认为,除了纤维性或哑铃状LPA外,对大型或巨大型垂体腺瘤取经蝶入路显微外科手术切除是一种安全、有效的方法,可使视神经和视交叉获得迅速而充分的减压。

TECHNIQUE OF TRANSSPHENOIDAL MICROSURGICAL REMOVAL FOR LARGE PITUITARY ADENOMAS

To probe the effect of transsphenoidal microsurgical removal on large pituitary adenomas (LPA), a total of 1 520 patients suffering from LPA were diagnosed by skull X ray plain films, CT, or MRI scanning. Operations were performed via a transsphenoidal approach under microscope. The results showed that gross total removal of an adenoma in 1 264 cases ( 83 2% ) and subtotal removal in 195 cases ( 12 8% ) were achieved; partial removal was carried out in the remaining 61 cases ( 4 0% ) of fibrous or dumbbell shaped adenomas. Death occurred in two patients (0 1%) after surgery. Long term follow up review( median: 3 5 years ) in 1 240 patients revealed that 1 219 cases( 98 3%) of those with preoperative diminished visual acuity had postoperative improvement; 21 cases (1 7%)had no change, and none deteriorated significantly. Among the 1 226 patients with preoperative visual field defects, postoperative improvement was good in 1 186 (96 7%), and poor in 40(3 3%).It is concluded that microsurgical removal of pituitary tumors by transsphenoidal approach is safe and very effective even for very large or giant adenomas except for fibrous and dumbbell shaped ones, since it allows rapid and adequate decompression of the optic nerves and chiasm.