巨大垂体腺瘤的手术及并发症

目的对垂体巨腺瘤显微手术的方法及结果进行分析,总结术后并发症的发生原因、预防及治疗效果。方法回顾性分析1981年12月-2000年12月206例经CT、MRI及内分泌检查确诊的巨大型垂体腺瘤手术资料;其中A组83例单纯经翼点入路开颅肿瘤切除术,B组97例单纯经鼻前庭-鼻中隔-蝶窦入路肿瘤切除术,C组26例联合用以上两种方法分次切除肿瘤。结果全切或次全切A、B、C组分别为42例(50.6％),21例(21.6％),24例(92.3％);死亡三组依次为2例(2.4％),1例(1.03％),0;尿崩三组分别为51例(61.4％),18例(18.6％),11例(42.3％);下丘脑受损三组依次为26例(31.3％),2例(2.1％),0。三组全切除率、尿崩率比较,经卡方检验,均P<0.01,有非常显著差异。结论在严格掌握经翼点及经鼻蝶入路手术适应证的情况下,取两者各自的优点,对巨大型垂体腺瘤行分期、分次切除是一种提高全切率、降低死亡率和复发率、减少并发症的安全、有效的治疗方法。在严格掌握经翼点及经鼻前庭-鼻中隔-蝶窦入路手术适应症的情况下,利用两者各自的优点,取长补短,对巨大型垂体腺瘤分别用经翼点和经鼻前庭-鼻中隔-蝶窦入路分期、分次切除肿瘤是一种提高全切率、降低死亡率及复发率、减少并发症的安全、有效的治疗方法。

Microsurgical treatment and complication for giant pituitary adenoma

Objective To analyze the outcome and therapeutic methods of microsurgical for giant pituitary adenoma and summarize the causes of postoperative complications as well as the preventive and therapeutic effects. Methods Retrospective analysis was performed on postoperative outcomes of giant pituitary adenoma in 206 patients between 1981 and 2000, who were affirmatively diagnosed wtih CT, MRI and endocrine examine. 83 patients receiving craniotomy via pterional approach were put into group A, 97 via the naso-vestibulo-sphenoidal approach in group B, 26 via the combined approach in group C. Results The total or subtotal removal were achieved in 42 cases (50.6 %), 21 cases (2.1 %), and 24 cases (92.3 %) in groups A, B and C respectively and the deaths after operation were 2 cases (2.4 %), 1 case (2.4 %) and 0 respectively. Diabetes insipidus occurred in 51 cases (61.4 %), 18 cases (18.6 %), and 11 cases (43.2 %) respectively and hypothalamus damage in 26 cases (31.3%), 2 cases (2.1 %), 0 respectively. The statistical differences in the total removal rate and diabetes insipidus were significant between the three groups (P<0.01). Conclusion Within the limits of the indications, the microsurgery via combined naso-vestibulo-sphenoidal approach and pterional craniotomy for two times, as a safe and effective therapy, can increase the total removal rate of giant adenoma and decrease the mortality, recurrence and complication.