经蝶窦入路显微手术治疗垂体腺瘤疗效分析

目的 探讨经蝶窦入路显微手术治疗垂体腺瘤的疗效.方法 回顾性分析经蝶窦入路显微手术治疗的垂体腺瘤患者49例,结合临床手术情况、术后视力、内分泌功能改善情况及并发症发生情况综合评估其疗效,分析术中要点和并发症防治措施.结果 本组全切术42例,次全切术7例;手术时间（1.31±0.26） h,平均出血量为（67.3±13.4） mL.功能改善：术前视力障碍31例,缓解29例,视功能改善率93.5%;术前内分泌紊乱47例,缓解43例,内分泌功能改善率91.5%.并发症：术后尿崩11例,脑脊液鼻漏3例,颅内感染2例,垂体功能低下2例,鼻腔黏膜出血1例,并发症发生率38.8%;经对症治疗,所有患者均得以缓解,无术后死亡病例.结论 经蝶窦入路显微手术治疗垂体腺瘤疗效显著;熟练掌握术中操作要点,谨慎操作,严密监测术后并发症,及时干预,是提高手术疗效的关键措施.

Effect analysis of transsphenoidal microsurgery on pituitary adenomas

Objective To investigate the effect optimization measures of transsphenoidal microsurgery for pituitary adeno- mas. Methods 49 cases of patients with pituitary adenoma in our hospital were retrospectively studied who were all treated by transsphenoidal microsurgery. The key points and preventive measures for complication were summarized on the basis of thera- peutic effect evaluation according to the comprehensive conditions of surgery situation, postoperative vision, endocrine func- tion, and complications. Results surgery situation： There were 42 cases of pituitary adenoma full resection and 7 cases of sub- total resection in this research with an average operation time of （1.31 ± 0.26）h and an average bleeding of （67.3 ± 13.4）ml. Function improvement： There were 31 cases of visual disturbance before surgery, among whom 29 cases improved in postoper- ation with an improvement rate of 93.5%; And there were 47 cases of endocrine disorder before surgery, among whom 43 cases improved in postoperation with an improvement rate of 91.5%. Postoperative complications： There was a total incidence of 38.8% with urine collapse in 11 cases, nasal cerebrospinal fluid leakage in 3 cases, intracranial infection in 2 cases, dyspituitar- ism in 2 cases, and nasal mucosa bleeding in 1 case, which were all eased after symptomatic treatment with no postoperative deaths. Conclusion Our research result shows that transsphenoidal microsurgery has significantly curative effect for pituitary adenoma with little invasion, which effectiveness could got further improvment on the basis of three key points： mastering con- summate skill, operate prudently, and handling the complication closely.