经蝶窦显微手术治疗高龄垂体腺瘤

目的 总结高龄(大于70岁)患者垂体腺瘤的临床特点、显微手术治疗和围手术期处理的体会。方法 回顾经蝶窦显微手术治疗的24例，对其临床特点、肿瘤病理类型、手术适应证、围手术期处理和手术疗效进行了分析和总结。结果 无功能腺瘤占66．7％(16／24)，巨大腺瘤占75％(18／24)，临床上最常见的主诉为进行性视力、视野障碍。术后无死亡，其中22例获得长期随访，随访时间平均3．5年，79．2％患者(19／24)术后视力有不同程度改善。结论 高龄垂体腺瘤以无功能巨大腺瘤多见，临床上主要表现为进行性视力、视野障碍和垂体功能低下，经蝶窦显微手术是一种安全有效的治疗手段，但要加强围手术期的处理，特别要注意保持水、电解质平衡。

Thanssphenoidal mircrosurgery for the elderly patients aged over 70 years with pituitary adenoma

Objective To summarize the clinical features and transsphenoidal microsurgical experiences of pituitary adenomas in the elderly patients over 70 years old Methods Twenty four elderly patients accepted transsphenoidal microsurgery were conductded a retrospective review,whose clinical data including clinical main presentation,histological types,surgical conditions,perioperative treatment and outcome were also analyzed Results There were 16 non functional adenomas (66 7%) and 18 giant macroadenomas(75%) respectively Visual deterioration was the commonest complain in 20 (83 3%) Despite the majority of patients having coexisting medical conditions,we had no mortality and no postoperative adjunctive morbidity with an average hospital stay of 17 8 days For an average follow up of 3 5 years,we did observe major patients(79 2%) vision had improved Conclusions Pituitary adenomas in the elderly are most frequently non functional macroadenomas that present with visual deterioration and hypopituitarism If special care is devoted to the perioperative treatment,in particular to fluid and electrolyte balances,transsphenoidal microsurgery is safe and effective in hands of an experienced team