额下入路和单鼻孔经蝶入路手术切除鞍内鞍上型垂体腺瘤的对比研究

目的研究额下入路（额下组）和单鼻孔经蝶入路（单鼻孔组）手术切除鞍内鞍上型垂体腺瘤的疗效和特点。方法回顾性分析27例经额下入路与38例单鼻孔经蝶入路手术切除鞍内鞍上型垂体腺瘤患者的临床资料,对比两组患者手术前后内分泌、影像学和临床表现。结果额下组肿瘤全切17例,次全切7例,部分切除3例;单鼻孔组全切28例,次全切8例,部分切除2例。视力视野障碍恢复正常或明显改善者额下组19例,单鼻孔组33例。患者术后泌乳停止或减少额下组8例,单鼻孔组14例。额下组术后出现尿崩9例,术侧视力下降3例,嗅神经损伤12例。单鼻孔术后脑脊液鼻漏4例,尿崩11例。结论对于手术治疗鞍内鞍上型垂体腺瘤来讲,额下入路和单鼻孔经蝶入路均是两种有效的手术方式,单鼻孔入路在肿瘤切除后内分泌改善方面和残存垂体功能保护方面优点更明显,创伤小,手术时间短,并发症少。

Control study of subfrontal approach and endonasal transsphenoidal approach for the surgery of pituitary adenomas

Objective To study the curative effect and characteristic of subfrontal approach （subfrontal group） and endonasal transsphenoidal approach （endonasal group） for the surgery of pituitary adenomas. MethodR Etrospective analysis the clinical data of 27 subfrontal approach patients and 38 endonasal transsphenoidal approach patients who had the surgery of pituitary adenomas. Contrast the endocrine,imageology and clinical manifestation before and after surgery between the two approaches. Results For subfrontal group,17 cases of total tumorectomy,7 cases of subtotal tumorectomy,3 cases of partial tumorectomy. For endonasal group,28 cases of total tumorectomy,8 cases of subtotal tumorectomy,2 cases of partial tumorectomy. Patients with disturbance of visual field and vision turned to be normal or obviously improvement：19 cases in subfrontal group and 33 cases in endonasal group. Patients with disappear or decrease of lactation：8 cases in subfrontal group and 14 cases in endonasal group.9 cases of diabetes insipidus,3 cases of monocular deprivation and 12 cases of injury of olfactory nerve were seen in subfrontal group. 4 cases of cerebrospinal rhinorrhea and 3 cases of diabetes insipidus were seen in endonasal group. Conclusions Subfrontal approach and endonasal transsphenoidal approach were effective methods for the surgery of pituitary adenomas. Endonasal transsphenoidal approach revealed a much more obvious advantage in total tumorectomy and relic pituitary function protection. Endonasal transsphenoidal approach is of low traumatic,less surgery time and low complication.