眉弓锁孔入路治疗垂体大腺瘤的临床研究

目的 探讨眉弓锁孔入路治疗垂体大腺瘤的临床疗效.方法 分析山东省三家医院2006年5月至2009年9月经颅手术治疗证实的127例垂体大腺瘤,其中53例经眉弓锁孔入路,74例经传统翼点或冠状切口额下入路,比较两组手术效果和并发症.结果 两组手术全切率,垂体内分泌功能及视力、视野改善,术后水电解质代谢紊乱、垂体前叶机能减退、下丘脑损伤相比差异无统计学意义（P＞0.05）;锁孔入路组术后平均住院天数、皮下积液率、额叶症状和局灶性脑缺血低于传统入路组（P＜0.05）.结论 眉弓锁孔入路有微创、暴露充分、术后平均住院天数少、额叶症状和皮下积液发生率低等优点,适于向鞍上、鞍旁生长的垂体腺瘤的治疗.

Clinical research of microneurosurgery for pituitary adenoma with superciliaryarch-keyhole approach

Objective To study clinical effects and complications of minimal invasive neurosurgery for pituitary adenoma through superciliaryarch-keyhole approach. Methods 127 cases pituitary adenoma in three hospitals in Shangdong province from May. 2006 to Sept. 2009 confirmed by surgery were analyzed. Patients were treated by different operative approaches, 53 cases using surgery through superciliaryarch-keyhole approach and 74 cases through conventional subfrontal approach. Clinical parameters were compared in patients undergoing surgery through different approaches. Results There were no differences in two groups, in aspects such as resection rate, improvment of endocrine hormone secretion and acuity of vision with campus visualis, electrolyte disturbances, hypothalamus damage (P ＞0.05). Significant differeces reside in average hospitalization days, subcutaneous fluidify, psychiatric symptom and circumscribed cerebral ischemia ( P ＜ 0.05 ). Conclusion Advantages of minimal invasive neurosurgery through superciliary arch approach such as less trauma, better expose,shorter hospitalization days, less subcutaneous fluid accumulation and psychiatric symptoms in terms of this apporach are suitable for removing hypophyseal adenomas that grow on or around sella turcica.