经蝶进路垂体腺瘤切除术的体会及认识(附1 047例报告)

经蝶窦进路已成为耳鼻咽喉颅底外科行垂体腺瘤切除术的主要途径,但由于国人颅底解剖学参数与国外指标不同,不同医生临床经验又有很大差异,国内外学者在经蝶窦进路手术切除垂体腺瘤术前、术后处理等许多方面仍有分歧.我院从1982～2002年间开展经蝶窦进路显微手术治疗垂体瘤,共1 047例,取得较好疗效.本文分析1 047例患者的临床资料,总结临床经验,对与手术相关的一些问题(如垂体腺瘤的大小诊断标准、手术适应证、垂体卒中的经蝶手术、复发性垂体瘤再次经蝶手术、术后并发症的处理、术后放疗以及蝶鞍区重要解剖结构等)进行探讨,以提高手术成功率和疾病的治愈率.

Transsphenoidal resection of pituitary adenomas: experience of 1 047 cases

Transsphenoidal microsurgery has become a major approach for removal of pituitary adenomas. Due to the anatomic differences of skull base between Chinese and foreigners and the different experience of surgeons, the pre- and post-operation managements of the operation are different. From 1982 to 2002, a total of 1 047 patients received transsphenoidal removal of pituitary adenomas in our hospital and gained satisfactory outcomes. This article summarizes our experience on 1 047 patients and discusses some relevant problems, including the diagnostic standards of adenoma size, surgery indications, the apoplexy operation, the re-operation for recurrent cases, management of complications, post-operation radiotherapy, and the anatomy of sphenoidal sinus and sellar area, hoping to improve the successful rate of the operation.