经蝶窦入路显微外科治疗垂体大腺瘤

目的：探索经蝶窦入路手术治疗垂体大腺瘤的效果。方法：1993年3月至1999年6月经蝶窦入路手术治疗垂体大腺瘤患54例。结果：全切除36例（66．7％），大部分切除12例（22．2％），部分切除6例（11．1％）。随访35例，随访时间7－34个月，其中31例视力视野恢复正常，MRI扫描鞍上结构恢复29例。主要并发症为尿崩症9例（16．7％）和脑脊液漏7例（12．9％）。所有病例术后接受放射治疗。结论：经蝶窦入路手术切除垂体大腺瘤是安全有效的，因为能迅速解除肿瘤对视神经和下丘脑的压迫。术后放疗效果有待长期随访证实。

Management of pituitary macroadenomas by transsphenoid microsurgery

Objective: : To evaluate the therapeutical effect of transsphenoid microsurgery for removing of pituitary macroadenomas. Met hods: Fifty four patients with pituitary macroadenomas between March 19 93 and June 1999 were treated with transsphenoid microsurgery. Results: Among the 54 patients, gross total removal of the tumor was achieved i n 36 cases, subtotal removal in 12 cases and partial removal in 6 cases. All pat ients received postoperative radiation therapy. Thirty five patients were follo wed up for 7 months to 34 months. Diminished visual acuity and visual field defe cts were improved in 31 cases. MRI scans postoperative showed normal suprasella r structure in 29 cases. The major complications after operation were diabetes i nsipidus and cerebrospinal fluid rhinorrhea, which occured in 16.7% and 12.9% of patients respectively. Conclusion: Transsphenoid microsurgery i s a safe and effective approach in the treatment of macroadenomas, it allows rap id and adequate decompression of optic chiasm and hypothalamus. The effectivenes s of postoperative radiation therapy need to be evaluated by long time follow up study.