改良经鼻蝶入路显微手术切除垂体腺瘤（附500例临床分析）

目的探讨经鼻蝶手术治疗垂体腺瘤的疗效，总结经鼻蝶手术治疗垂体腺瘤的手术技巧及并发症预防的经验。方法回顾性分析了近5年来我科经鼻蝶入路显微手术治疗500例垂体腺瘤的临床资料，对手术入路、手术切除程度、术后视力和内分泌的变化以及并发症等进行总结和分析。结果全部病例经鼻蝶入路，手术全切肿瘤450例，次全切除43例，部分切除7例。术前有视力障碍的患者97．9％术后视力得以改善；功能性腺瘤手术后86．2％以上激素水平恢复正常；无病例死亡及严重并发症。结论经鼻蝶入路显微手术切除垂体腺瘤疗效满意，具不需剃头、损伤小、手术时间短、肿瘤全切率高、并发症少、术后康复时问短、手术死亡率极低、垂体功能保存率高等优点，可作为绝大多数垂体腺瘤患者的首选治疗方法。

Resecting Pituitary Adenomas by Improved Transsphenoidal Microsurgery (Report of 500 cases)

Objective To explore the curative effect of transsphenoidal microsurgery on pituitary adenomas and to summarize the experiences in treating pituitary adenomas by the transphenoidal microsurgery and preventing the postoperative complications. Methods The clinical data of 500 patients with pituitary adenomas, who underwent the transsphenoidal microsurgery for pituitary adenomas during the past 5 years in our department, were reviewed. The surgical approach, extent of resecting the tumors, ohanges in the vision, visual field and endocrinology as well as the postoperative complications analyzed retrospetively. Results Of 500 patients with pituitary adenomas resected by microsurgery through transsphenoidal approach, 450 received total resection of the tumors, 43 subtotal and 7 partial. The visual field and vision in 97.9% of patients with visual field and vision disturbances before the operative were improved after the operation. The level of blood hormone in the patients with functional adenomas returned to normal following the operation. There were not severe complications and nobody died in all the patients. Conclusion The microsurgery through transsphenoidal approach for the pituitary adenomas had advantages such as not hair-shaving, minimal invasion, short operative time, high rate of total resection of the tumor, few complications, good preservation of pituitary function and rehabilitation as well as very low mortality. The transsphenoidal microsurgery should be first selected in the patients with pituitary adenomas.