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目的 :分析经鼻蝶显微手术治疗垂体大腺瘤的疗效,对手术技术进行探讨。方法 :回顾分析2012年5月—2015年4月行经鼻蝶显微手术切除的垂体大腺瘤患者220例,对其临床症状、影像学、内分泌、肿瘤切除率和手术并发症进行总结分析。结果:头颅磁共振(magnetic resonance image,MRI)显示肿瘤全切198例,次全切20例,部分切除2例;术中脑脊液漏47例,术后尿崩129例;术后三碘甲状腺原氨酸(triiodothyronine,T3)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、促甲状腺激素(thyroid stimulating hormone,TSH)、泌乳素(prolactin,PRL)及促肾上腺皮质激素(adrenocorticotrophic hormone,ACTH)下降,生长激素腺瘤患者生长激素(growth hormone,GH)下降。结论:经单鼻孔蝶窦入路显微手术,技术成熟,能够切除垂体大腺瘤,是一种安全、有效的手术技术。
Objective: To analyze the curative effect of transnasal microsurgery on pituitary adenoma and to discuss the surgical technique. Methods: 220 patients with giant pituitary adenomas resected by nasal microsurgery from May 2012 to April 2015 were retrospectively analyzed. The clinical symptoms, imaging, endocrine, tumor resection rate and surgical complications were analyzed. Results: Magnetic resonance imaging (MRI) showed 198 complete resections, 20 subtotal resections and partial resection in 2 cases. Cerebrospinal fluid leakage occurred in 47 cases and postoperative insomnia occurred in 129 cases. Postoperative triiodothyroidism Triiodothyronine (T3), free triiodothyronine (FT3), thyroid stimulating hormone (TSH), prolactin (PRL) and adrenocorticotrophic hormone (ACTH ) Decreased, growth hormone (growth hormone, GH) decreased in patients with growth hormone adenoma. Conclusion: Microsurgery via single nostril sphenoid sinus approach is a safe and effective technique for surgical resection of pituitary adenoma.