经单鼻孔蝶窦入路切除垂体大腺瘤

【作者】 周开宇； 王广涛； 金杭煌；

【机构】 浙江台州市立医院神经外科；

【摘要】 目的探讨经蝶入路手术治疗垂体大腺瘤的方法与疗效。方法回顾性分析采用经单鼻孔蝶窦入路显微手术治疗34例垂体大腺瘤的临床资料,对显微手术方法进行总结并分析肿瘤切除程度、术后视野恢复情况、手术前后血清激素水平变化。结果手术无死亡。术后行MRI、视野复查显示,近全切除23例(67.65%),术后视野恢复好转率91.30%;次全切除5例(14.71%),术后视野恢复好转率80.00%;大部分切除4例(11.76%),术后视野恢复好转率75.00%;部分切除2例(5.88%),术后视野恢复好转率50.00%;术后总体视野恢复好转率85.29%;手术前、后血泌乳素、生长激素的下降有统计学上的差别(前者t=2.57,P<0.05;后者t=3.01,P<0.05)。28例随访4～73个月,平均27个月,9例接受立体定向放射外科治疗,15例(53.57%)治愈,10例(35.71%)控制,3例(10.72%)复发。结论经蝶窦入路手术切除垂体大腺瘤是安全有效的方法,能使大部分患者的视野缺损好转、对功能性腺瘤能明显降低激素水平。更多还原

【Abstract】 Aim:To investigate the methods and effects to remove pituitary macroadenoma. Methods Records of 34 pituitary macroadenoma cases received microneurosurgery via the single side of norstril-sphenoidal approach were retrospectively analyzed,to summarize the microneurosurgery、the extent of resection and the visual field defect recovery、changes of serumal hormone level before and after operation. Results No surgery-related deaths were observed.Postoperative MRI and the visual field defect examination revealed:a gross total resection was achieved in 23 cases,The improvement rate of visual field efect recovery after operation was 91.30%;a subtotal resection in 5 cases,The improvement rate of visual field efect recovery after operation was 80.00%;a partial resection was achieved in 4 cases,The improvement rate of visual field efect recovery after operation was 75.00%;and a partial resection was achieved in 2 cases,The improvement rate of visual field efect recovery after operation was 50.00%;The total improvement rate of visual field defect recovery after operation was 85.29%.The differences of statistical significance were found in serumal PRL or GH hormone level before and after operation(P<0.05).Follow-up observations were carried out for 4～73 months(mean,27months) in 28 cases.9 cases were received stereotactic radiosurgery,15 cases were cured, 10 cases were controlled,3 cases were recurrence. Conclusion Via the single side of norstril-sphenoidal approach microsurgery is a safe and effective option for the treatment of pituitary macroadenoma.And make the visual field defect of the majority of cases be improved,significantly decreases the serum hormone levels of functional adenoma.更多还原