摘要目的 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.

abstractsObjective 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.