再次经蝶窦入路治疗复发性垂体腺瘤

目的:探讨经蝶窦术后残留或复发性的垂体腺瘤再次经蝶窦入路手术的手术指征、临床疗效及并发症。方法:回顾性分析了27例经蝶窦入路术后残留或复发的垂体腺瘤患者,其中无功能腺瘤患者13例,内分泌激素腺瘤患者14例,均选择经蝶窦入路再次手术。结果:垂体腺瘤全切6例,次全切9例,大部分切除7例,部分切除5例,术后无严重并发症发生,无功能腺瘤的临床症状缓解率为92.3%(12/13),随访1～5年,早期症状缓解患者中16.7%(2/12)出现肿瘤复发;有内分泌功能腺瘤64.3%(9/14)术后症状缓解,随访1～5年,早期内分泌症状缓解患者仍有33.3%(3/9)复发。结论:经蝶窦入路术后残留或复发的垂体腺瘤可以选择经蝶窦入路再次手术,能降低术后的致残率和致死率;以肿瘤占位效应为主要症状的残留或复发性腺瘤的疗效优于高内分泌激素腺瘤。

Repeated transsphenoidal surgery for recurrent or residual pituitary adenoma

Objective: To discuss the indications for and the efficiency and complications of repeated transsphenoidal surgery (RTSS) in the treatment of recurrent or residual pituitary adenoma after first transsphenoidal surgery. Methods:A retrospective analysis was performed on 27 patients who received RTSS to remove recurrent or residual pituitary adenoma after first transsphenoidal surgery. Thirteen cases had nonfunctional pituitary adenoma and 14 cases had hormone hypersecretion. Results:Patients suffering from pituitary adenoma underwent total resection (6 cases), subtotal resection (9 cases),mostly resection,and partly resection(5 cases). No severe complications occurred after RTSS. Clinical remission occurred in 92.3%(12/13)of patients with nonfunctional pituitary adenoma and 16.7%(2/12)of patients initially experienced remission had a relapse after 1-5 years follow-up. Endocrinological remission occurred in 64.3% (9/14)of patients with hormone hypersecretion and 33.3%(3/9)of patients with an initial endocrinological remission showed a relapse after 1-5 years follow-up. Conclusions: RTSS is effective in the treatment of recurrent or residual pituitary adenoma after transsphenoidal surgery. RTSS can reduce the rates of morbidity and mortality. Patients with nonfunctional pituitary adenoma had better response to RTSS than those with hormone hypersecretion.