大型垂体腺瘤的显微手术治疗

目的探讨大型垂体腺瘤显微手术治疗方法和疗效。方法回顾分析我院1998年9月～2008年9月间409例大型垂体腺瘤的临床资料。根据肿瘤的大小、生长方式、影像学特点,分别采用了经鼻腔-蝶窦入路221例(54.0%),经额下-翼点入路103例(25.2%),翼点入路25例(6.1%),扩大翼点入路18例(4.4%),眉弓外侧锁孔入路42例(10.27%)。其中分期行额下-翼点入路和经鼻腔-蝶窦入路6例(1.47%)。结果409例大型垂体腺瘤全切除125例(30.6%),次全切除230例(56.0%),部分切除54例54(13.2%)。死亡8例(2.0%)。结论据肿瘤的生长特点和病人具体情况选择适当的手术入路是提高肿瘤全切除率、降低死亡率、改善病人术后生存质量的重要手段。

Microsurgical treatment of large pituitary adenomas

Objective To explore the microsurgical methods and therapeutic effects of large pituitary adenomas.Methods four hundred and nine cases of large pituitary adenomas during in the last ten years(from September 1998 to September 2008) were studied retrospecticely.All patients were treated by one of the five types of surgical approachs.transsphenoidal approach in 221cases(54.0%),subfrontal-transpterional approach in 103 cases(25.2%),transpterional approach in 25 cases(6.1%),extended transpterional approach in 18 cases(4.4%),lateral eyebrow keyhole approach in 42 cases(10.27%).6 patients(1.47%) were treated by subfrontal-transpterional combined with transsphenoidal approach.The surgical approches were detemined based on the size,the extensive direction and the imaging feature of tumor of each case.Results Total removal was achieved in 125 case(30.6%),subtotal in 230 cases(56.0%),portion in 54 cases(13.2%),8 cases were dead(2.0%).Conclusion Selecting appropriate surgical approaches based on features of each cases are key factor to improve total resection rate and decrease mortality and recurrence rate for lagre pituitary adenomas.