巨大垂体腺瘤二次经蝶手术30例分析

目的探讨巨大垂体腺瘤二次经蝶手术策略、技巧及术后并发症处理方法。方法回顾性分析30例巨大垂体腺瘤二次经蝶手术病人的临床资料，对手术切除程度、术后症状、激素水平变化及并发症处理等进行总结和分析。结果术后病理结果显示：无功能性腺瘤22例，其中无功能性促肾上腺皮质激素腺瘤1例；生长激素腺瘤8例。功能性垂体腺瘤病人术后激素水平均不同程度下降。术后并发一过性尿崩症9例，脑脊液鼻漏4例，无死亡或严重并发症病例。术后3个月行MRI复查17例，肿瘤全切除4例，次全切除7例。部分切除6例。结论对单纯经蝶或经颅入路均无法一期全切除或术后随访肿瘤复发的巨大垂体腺瘤病例．二次经蝶手术应作为首选治疗方法。

Second transsphenoidal surgery for giant pituitary adenomas: Analysis of 30 cases

Objective To investigate surgical strategies and skills for second transsphenoidal surgery and treatment of postoperative complications in patients with giant pituitary adenomas. Methods Clinical data of 30 patients with giant pituitary adenomas undergoing a second transsphenoidal surgery were analyzed retrospectively. The degree of tumor resection, postoperative symptoms, endocrine changes and treatment of complications were summarized and analyzed. Results The postoperative pathological results showed that non-functional adenomas was in 22 patients including silent adrenocorticotropic hormone-secreting adenoma in 1, and growth hormone adenomas in 8. Hormone levels in patients with functional adenomas declined to different degrees after surgery. The major postoperative complications were transient diabetes insipidus in 9 patients and cerebrospinal rhinorrhea in 4. No severe complications or death cases were reported.MR.I reexamination was performed in 17 patients 3 months after surgery, total tumor removal was achieved in 4 patients, subtotal removal in 7 and partial removal in 6. Condusion Second transsphenoidal surgery should be the first treatment choice for patients without one-stage total removal by transsphenoidal or transcranial surgery and patients suffering from recurrence of the adenoma.