垂体腺瘤经蝶显微手术的疗效分析

目的 探讨经蝶显微手术治疗垂体腺瘤的临床综合疗效、手术技巧、新技术应用等。方法 对于1997～2001年经蝶显微手术治疗的1462例垂体腺瘤患者的临床资料、影像学、内分泌及病理检查结果、肿瘤切除率、术后并发症以及随访结果进行回顾性总结和分析。结果 Hardy Ⅰ级的肿瘤全切率已达97．0％、Ⅱ级95．2％、Ⅲ级90．5％、Ⅳ级47．4％;术后患者临床症状及内分泌功能有显著改善,肿瘤复发率低(0．3％)。结论 随着神经显微操作技术的日益娴熟及新技术的应用,经蝶入路手术指征不断扩大,内窥镜和(或)神经导航辅助显微外科经鼻-蝶窦入路手术,是垂体腺瘤的首选治疗方法;肿瘤全切除的患者术后不必行常规放疗。

The clinical evaluation of patients with pituitary adenomas undergone transsphenoidal microsurgery

OBJECTIVE: To evaluate the overall effect of transsphenoidal microsurgery for pituitary adenomas in recent 5 years and to discuss the surgical technique, application of new technology and postoperative follow-up results. METHODS: The clinical presentation, image characteristics, endocrinal findings, pathological types, tumor removal percentage, postoperative complication and follow-up of 1 462 patients with pituitary ademomas who underwent the transsphenoidal microsurgery from 1997 to 2002 were analysed retrospectively. RESULTS: Total rate of tumor removal for the patients achieved 97.0% in the patients with Hardy I adenomas, 95.2% with Hardy II, 90.5% with Hardy III, and 47.4% with Hardy IV respectively. A significant postoperative improvement both in clinical symptoms and endocrinal paraments was achieved. The tumor recurrence rate was 0.3%. CONCLUSIONS: With the improvement of microsurgical technique and application of novel technology, the indication of transsphenoidal microsurgery for pituitary adenomas was increasingly extended. Endoscope and(/or) neurpnavigator-assisted microsurgery via transsphenoidal approach should be of the first choice for the treatment of pituitary adenomas. The routine postoperative radiotherapy is not required for patients with total tumor removal.