经单鼻孔蝶窦入路显微手术切除大型垂体腺瘤

目的探讨经单鼻孔蝶窦入路手术切除大型垂体腺瘤(最大径>3cm)的效果及其手术技巧。方法回顾性分析经单鼻孔蝶窦入路手术切除的43例大型垂体腺瘤患者的临床资料。结果肿瘤全切除31例,次全切除8例,大部分切除4例。术后1周视力下降、视野缺损改善36例。术后出现一过性尿崩症11例,脑脊液鼻漏2例,迟发性鼻腔出血1例。本组无死亡病例。术后42例随访3月～2年,视力下降、视野缺损均有不同程度改善,头部MRI示肿瘤无残留29例,部分残留13例。结论经单鼻孔蝶窦入路手术可有效切除大型垂体腺瘤,但需熟练掌握手术技巧,减少肿瘤残留。

Endonasal transsphenoidal microsurgery for large pituitary adenomas(report of 43 cases)

Objectives To study the technique of endonasal transsphenoidal microsurgery for large pituitary adenomas and to summarize the experience in treating the pituitary adenomas. Methods The clinical data of 43 patients with large pituitary adenomas who underwent endonasal transsphenoidal microsurgery for the tumors were analyzed retrospectively. Results Total removal of pituitary adenomas was reached in 31 patients, subtotal removal in 8 and partial removal in 4 cases. The visual power and field were improved in 36 patients after the microsurgery. Transient insipidus occurred in 11 patients and cerebrospinal fluid rhinorrhea in 2 patients. The epistaxis occurred in 1 patient 1 week after the microsurgery. No patients died. MRI should that of 42 patients were followed up from 3 months to 2 years, 13 had residual tumors and 29 not. Conclusions The endonasal transsphenoidal microsurgery should be selected firstly in patients with large pituitary adenomas. The skillful microsurgical technique is important to decrease in the tumorous residues.