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目的 探讨经蝶垂体腺瘤手术有关切口、鞍底修复等改良方法的优越性。方法 对 71例经蝶垂体腺瘤 (包括微腺瘤 10例 ,鞍内大腺瘤 2 6例 ,向鞍上扩展的大腺瘤 19例 ,侵及海绵窦并向鞍上扩展的大腺瘤 11例 ,复发性垂体腺瘤 5例 )手术采用单侧鼻内粘膜切口 ,49例肿瘤残腔及鞍底修复皆简化为仅用Tachocomb粘贴 ,骨性鼻中隔回复两侧粘膜之间原位。结果 本组肿瘤全切除 5 6例 ,次全切除 15例。视力下降者术后视力皆在短期内获得明显改善 ,无 1例并发脑膜炎、鼻中隔穿孔。 49例鞍底修复采用Tachocomb者 ,无 1例发生术后脑脊液漏。术后随访 2个月至 4年 ,5例肿瘤复发再次手术 ,66例生活自理 ,40例恢复原工作。结论 这些手术方法的改良简化并方便了手术 ,减少了损伤 ,防止了术后脑脊液漏、鼻中隔穿孔等并发症
Objective To investigate the superiority of modified methods such as incision of the transsphenoidal pituitary adenoma and repair of the saddleback. Methods Totally 71 cases of transsphenoidal adenoma (including 10 cases of microadenoma, 26 cases of adenoma of the saddle, 19 cases of large adenoma which spread to the saddle, large adenoma which invaded the cavernous sinus and extended to the saddle 11 cases, recurrent pituitary adenomas in 5 cases) surgery unilateral nasal mucosa incision, 49 cases of residual tumor and saddle repair were simplified to only Tachocomb paste, bony nasal septum in situ between the mucosa on both sides. Results The total resection of the group of 56 cases of tumors, subtotal resection in 15 cases. Visual acuity in postoperative visual acuity were significantly improved in the short term, no one case of meningitis, nasal septum perforation. Tachocomb was used in 49 cases of sellar repair, and no leakage of cerebrospinal fluid occurred in 1 case. All the patients were followed up for 2 months to 4 years. Five patients underwent reoperation of tumor recurrence. Sixty-six patients took care of themselves and 40 returned to their original jobs. Conclusion The improvement of these surgical methods has simplified and facilitated the operation, reduced the injury, prevented the postoperative cerebrospinal fluid leakage and nasal septum perforation and other complications