·622·ChineseGeneralPractice铺眦啦lo]1’越k2e·论著·分期经蝶入路手术治疗向鞍上生长的垂体无功能巨腺瘤的临床价值‘王剑新，漆松涛，彭玉平，曾浩【摘要】目的探讨分次经蝶入路手术治疗向鞍上生长的垂体无功能巨腺瘤的临床价值。方法回顾性分析我科资料齐全的68例向鞍上生长的垂体无功能巨腺瘤患者的临床资料，重点分析肿瘤的手术处理，术后肿瘤的残余情况及相应的处理措施。结果68例患者首次手术均采取经单鼻孔蝶窦入路手术。术后第1天MRI复查，一期手术鞍上扩展肿瘤全切者2O例(20．6％)，存在鞍上残余肿瘤者48例(79．4％)。术后3个月复查，残余肿瘤2l例下降至鞍窝底，8例下降至鞍窝内，3例下降至垂体柄水平和鞍窝入口处(下降率为66．7％)，均采用再次经蝶手术切除(下降后残余肿瘤的全切除率为96．9％)；1例患者肿瘤虽然下降，但仍伴有鞍上扩展的残余肿瘤，采用开颅切除术。其余的l6例有残余肿瘤的患者，由于术后MRI显示残余肿瘤小，采取持续临床观察，其中2例视力改善不明显者辅以伽马刀治疗。本组共32例接受了分期经蝶手术；无死亡病例；术后无脑脊液漏、脑膜炎、视力恶化发生；有2例术后常规CT检查中观察到鞍隔上少量出血，但不需手术处理。结论向鞍上生长的垂体无功能巨腺瘤宜采用分期经蝶手术切除治疗，疗效确切，并发症少；垂体无功能巨腺瘤向鞍上生长的方式应该是膨胀推挤性生长，而非侵袭破坏性生长；有关垂体腺瘤的生长方式问题尚需进一步研究。【关键词】无功能垂体腺瘤；经蝶入路；分期手术【中图分类号】R736．4【文献标识码】A【文章编号】1007—9572(2011)02—0622—03StagedlyTranssphenoidalOperationsonGiantNonfunctioningPituitaryAdenomawithSuprasellarExtensionWANG口n—xin，QI．Song—tao，PENGYu—ping，eta1．NanfangHospitalofSouthernMedicalUniversity，Guangzhou510515，China【Abstract】ObjectiveToexploretheclinicvalueofstagedlytranssphenoidaloperationsongiantnonfunctioningpitui-taryadenomawithsuprasellarextension．MethodsTheclinicaldataof68casessufferingfromgiantnonfunctioningpituitaryad-enomawithsuprasellarextension(SSE)admittedintoourdepartmentwereretrospectivelyanalyzed，whounderwentprimarytranssphenoidalsurgery，mainlyincludedataonintraoperativetreatmentmethods，adenomaremainderssturnoverandtreatmentduringfollowing—up，andsoon．ResultsAllpatientsweretreatedtranssphenoidally．20SSEadenomasweretotallyremoved(2O．6％)，andinother48cases(79．4％)，SSEresidueswereshowninMRIrecheckinthe1stdayafteroperation．After3months，the3rdMR1wasperformedonlytofindthat21remaindersdescendedtosellarfloor，8casesintointrasella，and3casesdowntothelevelofstalkhypophysialandtheentrancetothesella：aUofresisdualtumorsabovegotretranssphenoidalresection(thetotalremovalrateofdesendingSSEresiduesamountto96．9％)；therewere2adenomaremainderswithslightdescend，ob—viousSSEadenomscouldbevisible，whichwerepreformedbyatranstranialapproach；other12caseswithsmallSSEtumorFen—nantsweregivenconsecutiveclinicalobservation，ofwhich，2caseswereaidedbygrammerknifebecauseofunobviousvisualpromotionpostoperatively．Inthepresentgoroup，thereare32casesacceptingstagedlytranssphenoidaloperations．rhesurgicalmortalitywas0％．Themortalityofourserieswaszero，andtherewerenocaseofrhinorrhea，meningitisorvisualdeterioration．2patientshadsupradiaphragmaticbleedingobservedduringroutinepostoperativeCTthatdidnotrequireoperativerevision．Con-clusionStagedoperationswithtwoormultipletranssphenoidalresectionsofgiantnonfunctioningpituitaryadenomawithSSEhavemanyadvantagessuchasgoodtherapeuticeffectsandfewcomplications；Atthesametime，asthetumorgrowslarger，itshouldexpandandshovethesurroundingstructures，notinvadeanddestroythem...
