巨大垂体腺瘤的诊治

目的：探讨内镜经鼻蝶入路或联合翼点入路开颅手术分次切除巨大垂体腺瘤的治疗效果和并发症处理。方法回顾性分析45例巨大垂体腺瘤病人的临床资料,根据垂体瘤的不同生长类型,分别采取内镜经鼻蝶入路或联合翼点入路开颅手术分次切除肿瘤后,观察其临床疗效和术后并发症。结果一次手术肿瘤镜下全切除26例,次全切除12例,部分切除7例。两次手术全切除9例,次全切除6例。两次手术间隔时间为6~8周。术后并发症：一过性尿崩13例,脑脊液鼻漏5例,中枢性低钠血症2例,中枢性高热10例,垂体功能低下12例,以上均经术后对症支持治疗后好转或症状消失。蝶窦内感染3例,其中2例再次内镜下清理后好转,1例保守抗炎治疗痊愈。随访39例,时间2个月~3年,平均2.1年。复发9例,6例再次手术,余3例放弃治疗。结论对于巨大、向鞍上生长的垂体腺瘤,神经内镜和经颅手术联合分次切除肿瘤,是提高全切率、降低病死率及减少并发症的重要手段。

Diagnosis and treatment for giant pituitary adenomas

Objective To explore the surgical outcome and complications of limited removal in several sessions for giant pituitary adenomas via endoscopic transsphenoidal approach or in combination with pterional approach. Methods Clinical data of 45 patients with giant pituitary adenomas were analyzed retrospectively, who underwent fractional resection by craniotomy via endoscopic transsphenoidal or combined with pterional approach. The clinical outcome and postoperative complications were observed. Results In the first surgery, total removal was achieved in 26 patients, subtotal removal in 12, partial removal in 7. Nine patients got total resection and 6 got subtotal removal in the second surgery. The optimal interval between the two operations was 6 to 8 weeks. The postoperative complications included transient diabetes insipidus in 13 patients, cerebrospinal fluid nasal leakage in 5, central hyponatremia in 2, central high fever in 10 and hypopituitarism in 12. All the above symptoms were improved or disappeared after symptomatic support treatment. Sphenoid infection occurred in 3 patients including improvement in 2 by endoscopic debridement and recovery in 1 by anti-inflammatory treatment. Thirty-nine patients were followed up for 2 months to 3 years at a mean period of 2.1 years. The recurrence occurred in 9 patients including 6 receiving surgery again and 3 giving up. Conclusions Staged endoscopic transsphenoidal surgery combined with pterional approach could be an effective method for increasing total removal rate and decreasing the mortality and complications of giant pituitary adenomas.