经鼻蝶显微手术治疗垂体腺瘤（附122例报告）

目的 探讨垂体腺瘤经鼻蝶入路的指征和术中应注意的问题。方法 分析１２２例垂体腺瘤经鼻蝶显微外治疗的情况。结果 微腺瘤３２例，全切为３１例（９７％）。大腺瘤７５例，全切５１例（６８％），其中鞍上２０￣３０ｍｍ２２例，全切８例（３６％）。巨大型腺瘤鞍上超过３０ｍｍ１２例，仅４例全切。结论 垂体瘤鞍上部分超过２０ｍｍ经蝶手术不易全切，超过３０ｍｍ应采用经额入路。视力极差宜先经鼻蝶再经额两期手术。

Transsphenoidal Microsurgery for Pituitary Adenoma (Experiences of 122 cases)

Objective To assess the indications of transsphenoidal approach in microsurgery for resection of the pituitary adenoma and to discuss the key points in the management of these patients. Methods A series of 122 cases of pituitary adenomas were treated by transsphenoidal microsurgery. Their clinical data were analyzed retrospectively. Results In 32 microadenoma cases, total resections of the tumors were achieved in 31 (97 %). There were 75 macroadenomas cases, of which 22 had suprasellar extension 20-30mm, and the total resection rate in these patients were 51/75(68%) and 8/22(36%) respectively. The total resections were achieved only in 4 out of 12 huge macroadenomas with suprasellar extension larger than 30mm. Conclusions It is not easy to achieve total resections in those patients with suprasellacr extension of the tumor larger than 20mm. If the diameter of the suprasellacr tumor exceeds 30mm, the transfrontal approach may be the first choice. For patients with severely damaged vision, it is better to decompress via transsphenoidal approach first, then to remove the residual tumor transfrontally by second stage.