中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2009年
1期
12-15
,共4页
赵兵%魏宇魁%康军%王曲%姚勇%李桂林%马文斌%幸兵%杨义%任祖渊%苏长保%王任直
趙兵%魏宇魁%康軍%王麯%姚勇%李桂林%馬文斌%倖兵%楊義%任祖淵%囌長保%王任直
조병%위우괴%강군%왕곡%요용%리계림%마문빈%행병%양의%임조연%소장보%왕임직
垂体腺瘤%侵袭性%扩大经蝶窦入路
垂體腺瘤%侵襲性%擴大經蝶竇入路
수체선류%침습성%확대경접두입로
Pituitary adenoma%Invasion%Extended transsphenoidal approach
目的 探讨扩大经蝶窦入路治疗侵袭性垂体腺瘤的疗效.方法 回顾性分析采用扩大经蝶窦入路治疗117例侵袭性垂体腺瘤病例,对其疗效进行分析.结果 肿瘤向前方及额叶底部生长14例,向侧方生长包绕海绵窦103例,向后方生长破坏斜坡27例,突破鞍底向蝶窦生长45例,向两个方向以上的呈侵袭性生长者57例.手术显微镜下肿瘤全切除73例,次全切除40例,大部切除4例.手术并发症包括短暂性脑脊液鼻漏7例;脑神经不全麻痹5例;垂体功能低下5例;颈内动脉损伤2例;单眼失明2例;水久性尿崩症1例;无死亡病例.随访3个月-8年,2例患者出现肿瘤复发而予γ-刀治疗,无再手术病例.结论 采用扩大经蝶窦入路切除侵袭性垂体腺瘤,肿瘤显露满意,全切除率高,手术并发症少;但对于肿瘤未能完全切除或激素分泌型侵袭性腺瘤患者,仍需密切随访,必要时联合放射、药物等综合治疗.
目的 探討擴大經蝶竇入路治療侵襲性垂體腺瘤的療效.方法 迴顧性分析採用擴大經蝶竇入路治療117例侵襲性垂體腺瘤病例,對其療效進行分析.結果 腫瘤嚮前方及額葉底部生長14例,嚮側方生長包繞海綿竇103例,嚮後方生長破壞斜坡27例,突破鞍底嚮蝶竇生長45例,嚮兩箇方嚮以上的呈侵襲性生長者57例.手術顯微鏡下腫瘤全切除73例,次全切除40例,大部切除4例.手術併髮癥包括短暫性腦脊液鼻漏7例;腦神經不全痳痺5例;垂體功能低下5例;頸內動脈損傷2例;單眼失明2例;水久性尿崩癥1例;無死亡病例.隨訪3箇月-8年,2例患者齣現腫瘤複髮而予γ-刀治療,無再手術病例.結論 採用擴大經蝶竇入路切除侵襲性垂體腺瘤,腫瘤顯露滿意,全切除率高,手術併髮癥少;但對于腫瘤未能完全切除或激素分泌型侵襲性腺瘤患者,仍需密切隨訪,必要時聯閤放射、藥物等綜閤治療.
목적 탐토확대경접두입로치료침습성수체선류적료효.방법 회고성분석채용확대경접두입로치료117례침습성수체선류병례,대기료효진행분석.결과 종류향전방급액협저부생장14례,향측방생장포요해면두103례,향후방생장파배사파27례,돌파안저향접두생장45례,향량개방향이상적정침습성생장자57례.수술현미경하종류전절제73례,차전절제40례,대부절제4례.수술병발증포괄단잠성뇌척액비루7례;뇌신경불전마비5례;수체공능저하5례;경내동맥손상2례;단안실명2례;수구성뇨붕증1례;무사망병례.수방3개월-8년,2례환자출현종류복발이여γ-도치료,무재수술병례.결론 채용확대경접두입로절제침습성수체선류,종류현로만의,전절제솔고,수술병발증소;단대우종류미능완전절제혹격소분비형침습성선류환자,잉수밀절수방,필요시연합방사、약물등종합치료.
Objective To study the value of extended transsphenoidal approach to invasive pituitary adenoma.Method Between September 1999 and March 2007,117 patients with invasive pituitary adenoma underwent surgery via extended transsphenoidal approach.The clinical data and follow-up of this series were retrospectively analyzed.Resuits 14 adenomas extended anteriorly to anterior cranial base,103 laterally to cavernous sinus,27 posteriorly to elivus.Total tumor removal was achieved in 73 cases,subtotal removal in 40,and partial removal in 4.Transient postoperative complications included 7 cases of CSF fistulae,5 cases of partial cranial nerve palsy,and 5 cases of acute panhypopituitarism.Permanent neurological complications included 2 cases of carotid artery injury,2 cases of monocular blindness and one case of diabetes insipidus.There was no perioperative mortality.The follow-up period ranged from 3 months to 8 years.The tumor recurrence was observed in two patients and then was treated with gamma knife.There was no reoperation.Conclusion The extended transsphenoidal approach could provide excellent exposure of tumors.The rate of total tumor removal is high,while the complication is few.This procedure has been proved to be an effective and perfect way to remove invasive pituitary adenomas.Operation,radiotherapy and medicine treatment are comprehensive treatment for invasive pituitary adenomas.
