【作者】 赵鹏；

【导师】 刘伟国；

【作者基本信息】 浙江大学 ， 外科学， 2007， 硕士

【摘要】 目的：经蝶窦入路已成为颅底外科行垂体腺瘤切除术的主要途径。但由于国人颅底解剖学参数与国外指标不同，不同医生临床经验又有很大差异，国内外学者在经蝶窦入路手术切除垂体腺瘤术前、术后处理等许多方面仍有分歧。通过分析83例患者的临床资料，总结临床经验，对于手术相关的一些问题(如垂体腺瘤的大小诊断标准、手术适应证、垂体卒中的经蝶手术、复发性垂体瘤再次经蝶手术、术后并发症的处理、术后放疗以及蝶鞍区重要解剖结构等)进行探讨，以提高手术成功率和疾病的治愈率。方法：采用经蝶入路，为83例不同类型的垂体瘤患者进行显微切除术。结果：全切除38例(45.78％)，大部分切除32例(38.55％)，部分切除13例(15.66％)。主要并发症为鼻中隔穿孔0例、脑脊液漏8例(9.64％)、鼻腔粘连1例(1.20％)及尿崩症8例(9.64％)。结论：直接经蝶入路步骤简化、省时省力、容易掌握，可有效切除突向蝶窦、呈柱状向鞍上延伸及局限于蝶鞍内垂体腺瘤，无严重并发症发生。但该入路手术空间较狭小，术中需要精巧的显微外科手术器械，对于突向海绵窦的瘤体，因术野狭小，无法在直视下切除，只能凭借刮圈刮除时的手感，对术者的主观经验要求很高。随着神经内窥镜、神经导航仪、术中MRI和超声技术的应用，该入路中凭借主观经验切除肿瘤的步骤必将得到改进，准确而微创的切除肿瘤是必然趋势。经蝶垂体腺瘤切除术简便、安全、准确性高，且能减少对正常组织的损伤，减少并发症的发生，值得推广应用。更多还原

【Abstract】 Objectives: Transsphenoidal microsurgery has become a major approach for removal of pituitary adenomas. Due tO the anatomic differences of skullbase between Chinese and foreigners and the different experience of surgeons, the pre-and postoperation managements of the operation are different. This article summarizes our experience on 83 patients and discusses some relevant problems, including the diagnostic standards of adenoma size, surgeryindications, the apoplexy operation, the reoperation for recurrent cases, management of complications, postoperation radiotherapy, and the anatomy of sphenoidal sinus and sellar area, hoping to improve the successful rate of the operation.Method: 83 patients with different kinds of pituitary adenomas were operated by the direct transnasal transsphenoidal approach.Result: 38 tumors were excised totally. 32 tumors were excised subtotally. 13 tumors were excised partly. Cerebrospinal fluid rhinorrhea lay in eight patients. Eight patients suffered from diabetes insipidus.Conclusion:The direct transnasal transsphenoidal approach is an efective method that can shorten the operation time and reduce the morbidity of complications. It needs delicate operation implements and advanced equipments. For the pituitary adenomas invading into the cavernous sinus, the surgeons should have enough experience because they cann’t see some part of the tumor. With the development of neuronavigation, endoscope, intraoperativemagnetic resonance and supersonic imaging, the operation will become more accurate and minimal invasive.Transsphenoidal microsurgery is a safe, simple, minimally invasive and efetive procedure for pituitary tunlors.更多还原