【摘要】 目的　探讨经口鼻蝶窦显微切除大型垂体腺瘤的手术指征、显微外科操作要点及临床疗效。　方法　自 1998年 5月～ 2 0 0 3年 5月 ,采用经口鼻蝶窦入路切除大型垂体腺瘤 87例 ,对其临床资料进行回顾性总结。　结果　其中 81例肿瘤在手术显微镜下全切除 ,全切除率为 93 %,次全切除 6例。术后脑脊液鼻漏 7例 ,其中 1例继发颅内感染死亡 ,其余经治疗后痊愈。全部病例随访 2～ 60个月(平均 3 8 6个月 ) ,手术全切除的病例目前均无复发 ,次全切除的 2例分别于术后 40个月和 5 6个月复发。　结论　垂体腺瘤手术疗效取决于肿瘤的切除程度 ;经口鼻蝶窦入路显微切除大型垂体腺瘤是一种安全有效的方法 ,手术病例的选择和显微手术技巧是肿瘤能否全切除的关键因素。更多还原

【Abstract】 Objective To introduce the indications,microsurgical technique and outcomes of the transoral-nosal-sphenoidal approach for microsurgical removal of large pituitary adenomas. Methods From May 1998 to May 2003,a total of consecutive 87 patients suffering from large pituitary adenomas were removed via transoral-nosal-sphenoidal approach and the clinical data were retrospectively reviewed. Results The gross total removal in 81 patients (93%),and subtotal removal in 6 patients (7%).Complication included CSF leak in 7cases and of the 7 cases,one was dead because of the intrainfection caused by CSF leak.All but the dead case were followed up for 2～60 months (mean 38.6 months),there were no recurrence in total removal patients and 2 recurrences in subtotal removal cases within 40 months,56 months respectively after operation. Conclusions The transoral-nosal-sphenoidal approach for removal of large pituiaary adenomas is a safe and effective way and has a good outcome.The key factor determining whether the tumors can be total removed is the microsurgical techique and the indications.更多还原