经翼点入路显微手术切除鞍区肿瘤66例临床研究

目的探讨经翼点入路显微手术切除鞍区肿瘤的方法及临床效果。方法对2000年1月至2012年2月收治的66例经翼点入路显微手术切除鞍区肿瘤患者进行回顾性分析总结。结果66例患者，肿瘤全切55例，次全切8例，大部切除3例。术后病理检查，垂体瘤38例，颅咽管瘤16例，脑膜瘤12例；术后32例发生尿崩，18例出现低钠血症，3例高钠血症，无手术死亡病例。54例患者随访6个月至5年，术前视力下降45例，术后视力恢复好转38例，无变化5例，恶化2例。肿瘤残留11例，术后行1刀放疗6例，肿瘤复发3例，1例鞍区并发眶内脑膜瘤。结论在经翼点入路行鞍区肿瘤显微手术中，熟练掌握规范的手术入路和局部显微解剖以及良好的显微外科技术是提高肿瘤全切率和手术疗效的保证。

Clinical research on microsurgery of sellar tumors through pterional resection in 66 cases

Objective To research the clinical effect of microsurgery of sellar tumors through pterional resection in 66 cases. Methods 66 patients suffered from sellar tumors treated by microsurgery through pterional resection in our department from January 2000 to February 2012 were retrospectively analyzed. Results Total resection were achieved in 55, subtotal in 81, partial in 3. The postoperative pathological examinations showed 38 cases were pituitary tumor, 16 cases eraniopharyngioma, 12 cases meningioma. After operation,32 patients developed diabetes insipidus, 18 patients hyponatremia and 3 patients hypernatremia. There was no operative deaths. 54 patients were followed up from 6 months to 5 years. Among 45 cases suffered from decreased visual acuity,38 cases had visual acuity improved,5 cases no changed and 2 eases deteriorated. Residual tumor were found in 11 cases. 6 patients received postoperative gamma-knife radiotherapy,3 patients developed tumor recurrence, and 1 patients saddle area recurrence concurrent with orbital meningiomas. Conclusions The key to succeed in sellar tumors microsurgery through pterional resection was to master standard surgical approach , local microscopic anatomy and microsurgical techniques, which can improve total resection rate and surgical treatment effect.