鞍上扩展型垂体腺瘤经蝶显微手术治疗

目的：为了对鞍上扩展型垂体腺瘤探索一种安全而有效的治疗手段．方法：回顾性总结了152例鞍上扩展型垂体腺瘤的诊断方式、手术技巧和治疗结果．均经CT扫描或MRI确诊，肿瘤向鞍上扩展直径＞10mm．在手术显微镜下经唇下-鼻中隔-蝶窦入路或经鼻前庭-鼻中隔-蝶窦入路两种方式行肿瘤切除术．术中于腰蛛网膜下腔予置一导管，用于注射生理盐水、以增加颅内压力的方法，使鞍上瘤块进入手术野，以利切除．结果：106例（69．7％）肿瘤获全切除；37例（24．4％）达次全切除；余9例（5．9％）系哑铃型或纤维性腺瘤，行部分切除．术后无死亡．对137例进行平均3．5a随访观察，其中97例（70．8％）恢复良好，40例（29．2％）肿瘤有复发，需行再次手术，或采用药物、放疗或放射外科治疗．结论：对非纤维性或哑铃型鞍上扩展型垂体腺瘤经蝶入路显微手术切除是一种安全、有效的方法．

The transsphenoidal microsurgical removal of pituitary adenomas with suprasellar extensions

Aim: To probe an effectual and safe surgicalapproach procedure on the removal of pituitary adenomas withsuprasellar extensions. Methods: The data of diagnosticmodes, surgical technique, and outcome of 152 patientssuffering from pituitary adenomas with suprasellar extensionswere reviewed. They were treated by transsphenoidalmicrosurgery in our department. Diagnosis was confirmed byCT or MRI scan. All tumors in our patients displayedsuprasellar extensions with diameters over 10 mm.Operations were performed via either sublabio-septo-sphenoidal approach or naso-vestibulo-sphenoidal approachunder microscope. During operation, a subarachnoid catheterwas inserted into the lumbar cistern,through which salinewas slowly injected to increase the ICP and deliver thesuprasellar tumor into the operative field to aid theremoval. Results: The gloss total removal of adenoma in 106cases (69. 7%) and subtotal removal in 37 cases (24. 4%)were achieved, and partial removals were carried out in theremaining 9 cases (5. 9%) with fibrous or dumbbell-shapedadenomas. There were no deaths after operation in thispatient group. Long-term follow-up review (median 3. 5years) in 137 patients revealed good recovery of 97 patients(70. 8%), with a 29. 2% late recurrence rate (40 cases).These patients with recurrence of tumor need furtherreoperative management, drug therapy, radiotherapy, andradiosurgery used either alone or combined. Conclusion:Microsurgical technique via trans-sphenoidal approach is a safeand effective way to remove the pituitary adenomassuprasellar extensions but not for those that are fibrous ordumbbell-shaped.