哑铃形垂体腺瘤经蝶显微手术技巧

背景与目的：哑铃形垂体腺瘤的手术治疗入路一直存在争议，本文探讨经蝶显微手术哑铃形垂体腺瘤的手术技巧和手术疗效。方法：回顾性分析经蝶显微手术治疗45例哑铃形垂体腺瘤的临床资料、手术疗效、术后并发症及随访结果。结果：全切除35例，次全切除7例，大部分切除3例。术后所有患者的临床症状得以改善，16／19患者的内分泌功能恢复正常。术后1周视力、视野恢复率分别为90．6％和81．3％。术后并发症有一过性尿崩17例、短暂性脑脊液鼻漏3例等，无持续性尿崩，无手术死亡。结论：除质地硬的哑铃形垂体腺瘤外，绝大多数哑铃形垂体腺瘤经蝶手术是安全、有效的。

The Techniques of Transsphenoidal Microsurgical Management for Dumbbell-shaped Pituitary Adenomas

BACKGROUND & OBJECTIVE:Transsphenoidal microsurgery for dumbbell -shaped pituitary adenomas is challenge for neurosurgeons. This study was to investigate surgical techniques and outcomes of transsphenoidal microsurgery for dumbbell -shaped pituitary adenomas. METHODS:Forty -five patients with dumbbell-shaped pituitary adenomas received transsphenoidal microsurgery were retrospectively investigated. The efficacy of the standard transsphenoidal surgical techniques and outcomes were analyzed. RESULTS:Thirty-five cases had total removal, 7 cases had subtotal removal, and 3 cases had partial removal. The clinical symptoms of all patients improved after surgery, including headache, amenorrhea and galactorrhea, impotence and decreased libido etc. The hormone levels of sixteen out of 19 of patients declined to normal postoperatively. Improvement of visual acuity and visual field within 1 week after operation was in 90.6% and 81.3% of the cases, respectively. There were 17 cases with transient diabetes insipidus, 3 with transient cerebrospinal fluid rhinorrhea and so on. There were no death and permanent diabetes insipidus after surgery. CONCLUSIONS:Except the tumor contains numerous hardy fibrous, transsphenoidal microsurgery is safe, effective and satisfactory.