经蝶窦手术治疗巨大垂体腺瘤

目的探讨经蝶窦手术治疗巨大垂体腺瘤的临床效果。方法从2005年3月至2008年12月，采用经蝶窦分次手术治疗直径大于4cm的巨大垂体腺瘤46例，其中无功能腺瘤24例，泌乳素腺瘤9例，生长激素瘤10例，促肾上腺皮质激素腺瘤1例，混合性腺瘤2例。结果本组患者1次手术31例，2次手术12例，3次手术3例。分次手术间隔为6～8W。全切除26例，次全切除20例。术后并发垂体功能低下2例，脑脊液漏2例，术后肢体偏瘫1例。无死亡病例。l例在手术后2年肿瘤复发。结论经蝶窦手术能有效治疗巨大垂体腺瘤。分次经蝶窦手术能有效提高手术全切除率并减少术后并发症。

Surgical treatment of giant pituitary adenomas via transsphenoidal approach

Objective To evaluate the curative effect of surgical treatment for giant pituitary adenomas via transsphenoidal approach. Methods Forty-six patients with giant pituitary adenomas （diameter 〉 4 cm） were treated from March 2005 to December 2008, including 24 cases of nonfunctional adenomas, 9 cases of prolactinomas, 10 cases of growth hormone adenomas, 1 case of adrenocorticotropic hormone adenoma, and 2 cases of mixed cell adenomas. Results Operations were performed once in 31 cases, twice on 12 cases, and three times on 3 cases. For the staged surgery, the optimal interval for the next operation was 6 to 8 weeks. Total tumor removal was achieved in 26 cases, and subtotal removal in 20 cases. Complications included hypopituitarism in 2 cases, cerebrospinal fluid leakage in 2 cases and paralysis in 1 case. There was no death case. Tumor recurred in 1 case 2 years later. Conclusion Staged surgery via transsphenoidal approach can improve total removal ratio and reduce complications, which is a safe and effective method for the treatment of giant pituitary adenomas.