摘要
为探讨大型垂体腺瘤(LPA)经蝶入路、应用显微外科技术治疗的效果 ,作者对 15 2 0例LPA以颅骨X线平片、CT或MRI等影像学检查做出诊断 ,采取经蝶入路、显微镜下进行肿瘤切除术的病例进行了回顾性分析。结果表明 ,12 6 4例 (83 2 % )获全切除 ,195例(12 8% )达次全切除 ,余 6 1例 (4 0 % )系哑铃型或纤维性腺瘤 ,仅获部分切除。手术后 2例 (0 1% )死亡。 12 4 0例进行平均 3 5年随访观察 ,有 12 19例 (98 3% )视力损害获得了恢复 ,仅 2 1例 (1 7% )无变化 ,但未见恶化 ;术前有视野缺损的 12 2 6例 ,术后 1186例 (96 7% )明显改善 ,4 0例 (3 3% )无变化。作者认为 ,除了纤维性或哑铃状LPA外 ,对大型或巨大型垂体腺瘤采取经蝶入路显微外科手术切除是一种安全、有效的方法 。
To probe the effect of transsphenoidal microsurgical removal on large pituitary adenomas (LPA), a total of 1 520 patients suffering from LPA were diagnosed by skull X ray plain films, CT, or MRI scanning. Operations were performed via a transsphenoidal approach under microscope. The results showed that gross total removal of an adenoma in 1 264 cases ( 83 2% ) and subtotal removal in 195 cases ( 12 8% ) were achieved; partial removal was carried out in the remaining 61 cases ( 4 0% ) of fibrous or dumbbell shaped adenomas. Death occurred in two patients (0 1%) after surgery. Long term follow up review( median: 3 5 years ) in 1 240 patients revealed that 1 219 cases( 98 3%) of those with preoperative diminished visual acuity had postoperative improvement; 21 cases (1 7%)had no change, and none deteriorated significantly. Among the 1 226 patients with preoperative visual field defects, postoperative improvement was good in 1 186 (96 7%), and poor in 40(3 3%).It is concluded that microsurgical removal of pituitary tumors by transsphenoidal approach is safe and very effective even for very large or giant adenomas except for fibrous and dumbbell shaped ones, since it allows rapid and adequate decompression of the optic nerves and chiasm.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2002年第7期573-574,共2页
Medical Journal of Chinese People's Liberation Army
基金
国家自然科学基金资助课题 (编号 39970 752 )
