垂体腺瘤手术入路选择

目的　探讨不同手术入路切除垂体肿瘤优缺点。方法　 95例垂体肿瘤选择不同手术入路 :经额下入路 73例 ;经额颞入路和翼点入路 10例 ;经蝶入路 7例 ;经双额前颅窝扩展入路和额眶蝶联合入路 5例。结合文献对各种手术入路进行回顾性分析。术后对病人分 0 .5、1、3、5年不同时间随访以确定疗效。结果　经额下入路 73例 ,全切除 2 8例 (38.36 % ) ,大部分和部分切除 45例 (6 1.6 4% ) ,死亡 3例 ,复发 16例。经额颞入路和翼点入路 10例 ,全切除 4例 (40 % ) ,大部分切除 6例 (6 0 % ) ,死亡 1例 ,复发 1例。经蝶入路 7例 ,全切除 3例 (42 .86 % ) ,大部分切除 4例 (5 7.14% ) ,死亡 1例 (鼻漏术后继发颅内感染 ) ,复发 1例。经双额前颅窝扩展入路和额眶蝶入路 5例 ,全切除 3例 (6 0 % ) ,大部分切除 2例 (40 % ) ,无死亡及复发。结论　垂体肿瘤手术时 ,一般采用经蝶显微外科手术入路 ,创伤小、恢复快、效果好 ;垂体肿瘤向鞍旁一侧生长时应选择额颞及翼点入路 ;对巨大或侵袭性垂体腺瘤适宜经双额前颅窝扩展入路和额眶蝶联合入路 ,该入路视野宽阔 ,全切除率高 ,复发及死亡率低 ;经额下入路手术视野小 ,全切除率低 ,易复发。

Operation approches of pituitary adenoma resections

Objectives Advantages and shortcomings of different approaches to resection of pituitary adenomas were questioned.Methods Ninety-five cases of pituitary adenomas: Seventy-three resections were performed by subfrontal approach; 10 by frontotemporal and pterional approach; 7 by sellar approach; 5 by bilateral transbifrontal and anterior fossa expanded or transorbitofrontosphenoidal combined approach; the different approaches were studied retrospectively. All the patients were followed up and therapeutic effect were evaluated at 6 months, 1 year,3 years and 5 years after the operation respectively.Results Seventy-three resections were performed by subfrontal approach, of which 28 (38.36%) were total resected and 45 (61.64%) were partial or portio major resected with 3 death and 16 recurrence, 10 by frontotemporal and pterional approach, 4 (40%) total and 6 (60%) partially resected, 1 death and 1 recurrence, 7 by sellar approach, 3 (42.86%) total and 4 (57.14%) portio major resected, 1 death (secondary intracranial infection after cerrebrospinal fluid rhinorrhea operation ) and 1 recurrence, 5 by bilateral transbifrontal and anterior fossa expanded or transorbitofrontosphenoidal combined approach, 3 (60%) total and 2 (40%) portio major resected, no death or recurrence.Conclusions Microneurosurigical sellar approach,with small wound, quick recovery and good effect, should be chosen if possible; When the pituitary adenoma grows to one side of sellae, frontotemporal and pterional approach can be chosen; Bilateral transbifrontal and anterior fossa expanded and transorbitofrontosphenoidal combined approach, because of its wide field of vision,higher total resection rate, lower recurrence rate and mortality, shoud be made to do with massive and invasive pituitary adenoma; Subfrontal approach has small field of vision and lower total resection rate and easily recurrence.