摘要
目的研究大型垂体腺瘤的显微外科治疗结果，探讨其治疗方法和策略。方法回顾2006年6月至2012年6月收治的垂体腺瘤病例，对56例直径超过3em的垂体腺瘤的临床及影像学资料、手术入路及显微操作技术、辅助放疗和药物治疗结果进行分析总结。结果经鼻蝶窦入路40例，经颅入路16例。肿瘤全切27例。次全切25例，部分切除4例。随访获得全切患者仅2例，2年后复发。未能全切除的29例患者中，动态观察无明显生长者9例，余20例行普通放疗者7例，伽玛刀治疗者13例，影像学复查肿瘤渐缩小或不增大。结论多数大型垂体腺瘤可首选经鼻蝶窦入路显微外科手术治疗。能否全切取决于肿瘤的质地和是否侵袭海绵窦。广泛侵袭海绵窦的巨大、分叶、多方向生长的垂体腺瘤，分期手术或结合放射治疗、药物治疗为较佳选择。
Objective To investigate the microsurgical treatment results of large pituitary adenoma,and discuss the treatment methods and strategies. Methods A retrospective study was performed amongst 56 eases of pituitary adenomas with a diameter of more than 3 cm by analyzing the clinical and imaging data and adjuvant therapy from June 2006 to June 2012 ; especially the surgical approaches and micromanipulations. Results In the 56 cases of pituitary, adenomas, 40 cases underwent adenomas resection via the single nostril transsphenoidal approach while 16 cases performed craniotomy. Total removal was achieved in 27 cases, amongst which 2 cases showed relapses in the two years during follow - up. Subtotal removal was achieved in 25 cases, and partial removal in 4 cases, in which 9 cases showed no growth stably and 7 cases underwent general radiotherapy while 13 cases underwent gannna knife radiotherapy, and all 20 cases showed shrinking or no increase of the adenomas. Conclusions Transsphenoidal microsurgery is the first choice for most large pituitm＇y adenomas. Whether a large or giant pituitary adenoma could be completely removed depends on tumor texture and cavernous sinus invasion. For multidirectional invasive giant pituitary adenomas, staging microsurgery accompanyed with medical therapy or radiotherapy may be the better choice.
出处
《中华神经外科杂志》
CSCD
北大核心
2013年第5期446-450,共5页
Chinese Journal of Neurosurgery
关键词
大型垂体腺瘤
显微手术
治疗选择
Large pituitary adenomas
Microsurgery
Treatment options
