单鼻孔蝶窦入路显微手术治疗垂体腺瘤

目的介绍26例经单鼻孔蝶窦入路显微手术治疗垂体腺瘤的经验。方法回顾性分析本院经单鼻孔蝶窦入路显微切除26例垂体腺瘤的临床资料。结果效果良好，肿瘤全切21例（80．8％），次全切4例（15．4．％），部分切除1例（4．8％）。结论经单鼻孔蝶窦入路显微手术治疗垂体腺瘤创伤小，操作简单，安全，肿瘤切除完全，住院时间短，费用低。     

显微手术经颅治疗垂体巨腺瘤

回顾分析了34例垂体巨腺瘤（直径≥4cm)经颅显微手术治疗的临床资料。所有病例均经翼点入路（23例），冠状切口入路（7例），右额马蹄形切口入路（3例）或联合切口入路（1例），采用显微手术切除肿瘤，其中腺瘤全切除28例，大部分切除6例，无死亡病例。所有病例均行术后放射治疗（放射剂量30－50GY／3－5周）。复发2例，占5．9％。结果表明，经颅显微外科手术治疗垂体巨腺瘤较为安全，可明显改善视觉功能，术后并发症少，也是提高全切率，降低死亡率和复发率的重要方法。     

垂体腺瘤显微外科治疗

目的：介绍36例垂体腺瘤经蝶显微手术切除治疗的经验。方法：回顾分析了我院经蝶入路显微切除36例垂体腺瘸的临床资料。结果：本组患者均经蝶入手术治疗取得良好效果，全切27例占75．0％；次全切7例占19．4％；大部分切除2例占5．6％。结论：对垂体腺瘤经蝶入路显微手术全切率高，患者术后恢复较快，且并发症少．无手术死亡，是值得推广的一种治疗手段。     

基层医院经蝶窦入路显微切除垂体瘤30例

目的探讨基层医院经蝶窦入路显微切除垂体瘤的手术方法与疗效。方法回顾性分析30例经蝶窦入路显微手术切除垂体瘤患者临床资料。垂体微腺瘤7例，大型垂体腺瘤18例，巨大型及复发性垂体腺瘤5例。经单鼻孔蝶窦入路26例，唇下经鼻中隔蝶窦入路4例。结果术后早期（1周内）复查的CT或MR，垂体微腺瘤全切除率达86．7％，大型垂体腺瘤全切除率达83．3％，巨大或复发性腺瘤全切除率达60．0％。术后短暂尿崩4例，脑脊液漏2例，鼻中隔穿孔1例，经治疗全部治愈。无颅内感染、视神经损伤等。术后月经恢复、性功能改善25例，8例要求生育者有6例术后1—9个月怀孕；视力改善27例；18例垂体内分泌激素恢复正常。结论经蝶窦入路显微切除垂体瘤是一种理想的治疗方法，可根据术者的经验及习惯采用经单鼻孔蝶窦入路或唇下经鼻中隔蝶窦入路显微手术，前者更具有损伤小、肿瘤全切除率高、术后恢复快、合并症少、生活质量高的优点。     

单鼻孔入路经蝶窦切除垂体腺瘤

目的总结我科经单鼻孔蝶窦入路显微镜下切除垂体腺瘤患者75例的手术经验。方法对75例垂体腺瘤患者手术入路、术中操作和并发症进行临床分析。结果垂体腺瘤全切除60例，大部分切除14例，活检1例，无死亡病例。术后患者症状均有不同程度的改善。结论单鼻孔蝶窦入路损伤小、安全和并发症少，适用于切除绝大多数垂体腺瘤。     

巨大垂体腺瘤显微外科治疗经验探讨

目的 探讨经额下和蝶窦手术入路显微外科切除巨大垂体腺瘤的方法和经验。方法 显微镜下分别采用经额下和蝶窦入路，对48例巨大垂体腺瘤实施手术治疗。结果 48例巨大垂体腺瘤中显微镜下全切除26例，近全切除19例，大部切除3例，无一例死亡。肿瘤未能全切除22例术后行放射治疗。47例平均随访4．5年，34例能正常工作，11例生活自理，复发2例。结论 显微外科手术治疗可提高巨大垂体腺瘤全切除率，降低病死率及复发率。     

大型垂体腺瘤经眉眶上锁孔入路切除术的护理

垂体腺瘤是发生于垂体前叶的良性肿瘤，约占颅内肿瘤的10％。手术是治疗垂体腺瘤的最有效的方法。采用经眉弓切口眶上锁孔入路能够在手术显微镜下切除大型、巨大型垂体腺瘤，而且手术创伤小，肿瘤切除彻底，不需剃头、不影响容貌，术后并发症少，恢复快。江苏省苏北人民医院神经外科2002年6月～2004年12月采用显微手术经眉切口眶上锁孔入路切除大型垂体腺瘤24例，     

经鼻蝶窦入路垂体腺瘤切除术

目的总结采用经鼻蝶窦入路切除垂体腺瘤的手术经验,探讨适应证选择、技术要点及并发症防治。方法回顾性总结经鼻蝶窦入路切除8例垂体腺瘤患者的病例资料,微腺瘤1例、大腺瘤6例、巨大腺瘤1例。结果8例均手术全切除,1例3年后复发再次手术治愈。随访3月至3年均治愈,术后3个月以上MRI复查未见肿瘤复发。结论经鼻蝶窦入路显微切除垂体腺瘤,具有手术创伤小、时间短、术后恢复快等优点,是治疗垂体腺瘤安全、有效的方法。     

经单鼻孔蝶窦入路显微手术治疗垂体腺瘤

目的：探讨经单鼻孔蝶窦入路显微手术治疗垂体腺瘤的手术适应证、手术技巧和临床治疗效果。方法：对20例采用该入路手术治疗的垂体腺瘤病人临床资料进行回顾总结。结果：全切15例,大部分切除3例,部分切除2例。14例视力、视野较术前有不同程度改善,3例月经恢复。结论：该手术入路是创伤较小,安全有效的治疗垂体腺瘤的手术方法。     

经单鼻孔-蝶窦入路切除垂体腺瘤22例临床分析

目的 观察经单鼻孔-蝶窦入路切除垂体腺瘤的临床疗效。方法 垂体腺瘤患者22例，均经单鼻孔-蝶窦入路切除肿瘤。先扩张术侧鼻孔，将扩鼻器直接插入鼻孔深处直抵蝶窦前壁，扩张后鼻中隔被完整地推向对侧；在手术显微镜下，分离蝶窦前壁的黏膜，然后凿除蝶窦前壁骨质，进入蝶窦。结果 本组均未发生严重永久性并发症，无一例死亡。16例（72．7％）随访3个月～2年，平均1．5年；12例（75．00％）治愈，3例（18．75％）控制，1例（6．25％）复发。结论 经单鼻孔-蝶窦入路损伤小，安全，并发症少，省时，简便易行，适用于切除大多数垂体腺瘤。     

内镜经鼻蝶术后垂体腺瘤患者腺垂体功能低下情况分析

[目的]检测垂体腺瘤患者内镜经鼻蝶术后相关激素水平变化,分析影响垂体功能低下的因素,指导其激素替代治疗.[方法]总结本院神经外科2008年至2013年内镜下经鼻蝶手术82例垂体腺瘤患者的临床资料及治疗方法,测定患者术前及术后d3甲状腺轴、肾上腺轴及性腺轴相关激素水平并进行比较.[结果]患者术后d3甲状腺轴及肾上腺轴激素水平较术前有所降低,发生腺垂体功能低下者共34例,占41.5%(34/82).高龄、术前存在垂体功能低下、无功能型、大型肿瘤患者术后发生垂体功能低下比例较高,其中微腺瘤发生率为16.7%(2/12),大腺瘤45.7%(32/70),45例无功能腺瘤发生腺垂体功能减低者16例,占35.5%.而术后腺垂体功能低下发生与患者性别无关.[结论]垂体腺瘤术后垂体相关各项激素水平较术前会有不同程度的下降;术前高龄、垂体功能低下、无功能性垂体腺瘤及肿瘤体积较大的患者,术后发生腺垂体功能低下可能性较高,合理的激素替代疗法有利于患者康复.     

侵袭性垂体腺瘤的诊治及其护理

目的 探讨侵袭性垂体腺瘤的临床特点与护理措施.方法 回顾分析62例侵袭性垂体腺瘤的临床表现、影像学表现及治疗效果,并结合同期78例非侵袭性垂体腺瘤的临床资料进行对比研究.结果 大腺瘤和巨大腺瘤的侵袭性腺瘤发生率(63.8%)明显高于微腺瘤和小腺瘤(15.9%),差异有统计学意义(P<0.01);功能性腺瘤和非功能性腺瘤中的侵袭性腺瘤发生率分别为44.8%,43.4%,差异无统计学意义(P>0.05);侵袭性腺瘤中肿瘤卒中的发生率(22.6%)明显高于非侵袭性腺瘤(5.1%);侵袭性腺瘤术后复发率(16.1%)明显高于非侵袭性腺瘤(3.8%);侵袭性腺瘤的手术全切率(46.8%)明显低于非侵袭性腺瘤(88.5%),有统计学意义(P<0.01).结论 侵袭性垂体腺瘤的诊断应结合影像学检查、术中所见和病理学检查来综合判定.手术全切率低,术后复发率高,治疗上应采取手术治疗结合放射治疗和药物治疗的综合治疗.加强对侵袭性垂体腺瘤术后的护理,可有效预防和减轻经蝶侵袭性垂体腺瘤术后并发症.     

垂体腺瘤的MRI表现与经蝶入路术中所见分析

目的　探讨垂体腺瘤的MRI表现对判断肿瘤质地的意义 ,侵袭性腺瘤的判断 ,以及经蝶入路切除垂体腺瘤的可行性和有效性。方法　回顾分析 2 0 0例经蝶入路手术垂体腺瘤患者的临床资料、MRI信号特点及手术情况。结果　 138例T2 像为高信号 ,肿瘤质软 ;T2 像呈稍高信号 2 4例 ,质地中等 ;T2 像呈等、低信号 38例 ,肿瘤质韧。术中发现有侵袭征象 12 6例 ,病理报告显示 139例鞍底硬膜被肿瘤侵袭 ,5 2例蝶窦粘膜有肿瘤侵袭。手术全切除肿瘤 170例 ,次全切除 17例 ,部分切除 13例。术前有视力障碍的患者 ,98%术后得以改善 ;功能性腺瘤患者术后 95 %以上激素水平恢复正常 ;无严重并发症。结论　MRI检查T2 像信号强度与垂体腺瘤的质地有关 ,显微镜下的侵袭性大多数在术中也可发现侵袭的征象 ;经蝶入路显微切除垂体腺瘤 ,即使是巨大腺瘤也是安全有效的。     

Section 4. Pituitary: New devices for direct transnasal surgery on pituitary adenomas

A micro-pressure-suction–irrigation system (MPSIS) is a surgical device that cleans the operative field of blood and tumor tissues with one-hand manipulation, dissects tumor tissue with its rapid flow, and removes debris by suction without injury to the normal tissue structures. Since 1997, good transnasal surgical results for pituitary adenomas have been achieved in Japan using this system. However, the surgical results for large, fibrous pituitary adenomas were unfavorable. Ultrasonic surgical aspirators with needle-type probes and an electromagnetic field system, all recently developed in Japan, are improving the results of direct transnasal surgery on pituitary adenomas. The MPSIS effectively dissects typical adenoma tissue with rapid irrigation and removes it by suction. A tumor in the cavernous sinus was removed by this system under direct vision in combination with pituitary mirrors. Fibrous adenomas were resected using ultrasonic surgical aspirators with needle-type probes. Thick mucosa and a firm tumor were vaporized with an electromagnetic field system. The sellar floor was reconstructed with combined ceramics, used in cases requiring additional surgery or drainage of cerebrospinal fluid leakage during surgery. Direct transnasal surgery with these devices was performed to remove 143 pituitary adenomas. Most of these pituitary adenomas could be selectively removed except for those lesions with extensive cavernous sinus invasion. There was no surgical morbidity or mortality. With the advancement of surgical technique and the development of surgical devices, most pituitary adenomas, even those that are fibrous or firm, can be removed via the transnasal route.     

MRI在侵袭性垂体腺瘤中的诊断价值

目的探讨MRI在侵袭性垂体腺瘤中的诊断价值,提高其术前正确诊断率。方法回顾性分析110例MR诊断并经手术病理结果证实的垂体腺瘤。结果MRI诊断52例侵袭性垂体腺瘤,表现为突破鞍隔向鞍上生长;侵入蝶窦;累及海绵窦、包绕颈内动脉。术中发现65例为侵袭性生长,MRI阳性预测值为86.5%。侵袭性垂体腺瘤以多功能腺瘤和泌乳素腺瘤多见,分别占33.8%、24.6%。结论MR诊断侵袭性垂体腺瘤具有较高的敏感性和阳性率,对治疗方案的选择有重要的指导意义。     

内镜下经单鼻孔蝶窦入路切除垂体腺瘤的临床研究

目的 探讨神经内镜下经单鼻孔蝶窦入路在垂体腺瘤切除术中的临床应用.方法 回顾性分析47例内镜下经单鼻孔蝶窦入路治疗垂体腺瘤患者的临床资料及手术方法,观察其疗效及并发症.结果 肿瘤全切除39例(82.9％),次全切除6例(12.8％),部分切除2例(4.3％).术后并发症有暂时性尿崩症11例,脑脊液鼻漏3例,术后鼻腔出血2例,颅内感染1例.无死亡病例.术后随访6～24个月,临床症状多有不同程度改善;术后内分泌学复查,25例激素水平降至正常,无肿瘤复发.结论 内镜下经单鼻孔蝶窦入路切除垂体腺瘤具有创伤小、并发症少、患者恢复快等优点,是治疗垂体腺瘤的一种安全、有效的方法.     

Management of pituitary incidentalomas: according to a survey of pituitary incidentalomas in Japan.

The development of computed tomography (CT) and magnetic resonance imaging (MRI) has resulted in the discovery of unsuspected endocrinologically silent pituitary masses (pituitary incidentalomas). The aim of this study was to clarify the natural history of pituitary incidentalomas in order to establish an appropriate approach to them. Five hundred fifty patients with pituitary incidentalomas were analyzed in this study; 261 patients (47.4%) underwent surgery (surgical group; SG), whereas 289 patients (52.6%) were followed up conservatively (nonsurgical group; NSG) for a mean period of 27.3 months (range, 6-173 months). Clinical and biochemical assessment, CT or MRI of the pituitary, and visual field testing were assessed at baseline and at 6 months and yearly thereafter. A total of 261 tumors in the SG group consisted of 211 (80.8%) nonfunctioning pituitary adenomas and 42 (16.1%) Rathke's cysts. During a follow-up period, of 289 tumors in the NSG group, 209 (72.3%) tumors stayed the same size as before, 35 tumors (12.1 %) increased in size, and 41 tumors (14.2%) decreased in size. The estimated diagnoses of the tumors that increased consist of 28 nonfunctioning pituitary adenomas, 5 Rathke's cyst, and 2 others. The decreased tumors consist of 11 nonfunctioning adenomas, 21 Rathke's cysts, and 3 others. Pituitary incidentalomas usually follow a benign course. We recommend transsphenoidal adenomectomy for a solid mass attached to the optic chiasma estimated to be a pituitary adenoma by MRI. Other patients should be followed up by MRI and biochemical assessment. Especially asymptomatic cystic masses (including Rathke's cleft cysts) could be followed up without surgical intervention because they tend to stay the same size or sometimes be cured spontaneously.     

胸内巨大淋巴结增生症的诊断与外科治疗预后研究(附16例分析)

目的回顾总结胸内巨大淋巴结增生症(CD)的临床特点、诊断和外科治疗效果。方法分析1982~2009年收治的16例胸内巨大淋巴结增生症患者,男女各8例,年龄19~52岁[(35.37±10.00)岁],均行手术治疗,另有2例分别行术前、术后放疗。随访10~318个月。结果术前确诊1例。局限性巨大淋巴结增生症13例(HV型11例,PC型1例,Mix型1例),多中心性巨大淋巴结增生症3例(PC型1例,Mix型2例),所有病例术后均生存,其中13例局限型和2例多中心型CD术后无复发。1例多中心Mix型患者于术后第4年、第9年各复发1次,均再次手术治疗。结论胸内巨大淋巴结增生症的诊断主要依靠病理学,胸内局限型CD和部分多中心型CD经彻底手术可获治愈;部分胸内多中心型CD手术治疗效果不佳,应辅助放射或其他综合治疗手段,但预后仍较差。     

Section 4. Pituitary: Gamma knife radiosurgery for pituitary adenoma

For the treatment of pituitary adenomas, transsphenoidal surgery is established as a first choice of treatment. However, pituitary adenomas are often not curable with surgery alone, and further treatment including radiation therapy is required to control the disease. In this report, we review the literature of gamma knife radiosurgery for pituitary adenomas and discuss the efficacy of this modern technology. Radiosurgery achieved 85–100% of growth control rates with only mild and transient neurological complications in most cases. Endocrinological normalization was obtained in more than 65% of GH producing tumors. These hormonal control rates seemed to be slightly better in GH producing tumors compared to ACTH producing tumors. To normalize the excessive GH or ACTH levels, radiosurgery for functioning adenomas requires a relatively higher dose, ideally more than 35 Gy at tumor margin. However, the adjacent optic apparatus is less tolerable for irradiation, and the tumors have to be sufficiently separated from it to prevent the radiation-induced visual deficits. Therefore, the role of surgery should not be underevaluated, and even if radiosurgery alone may be able to achieve an excellent outcome in some cases, surgical resection will remain the primary treatment for pituitary adenomas. For high-risk patients or patients with residual tumors after transsphenoidal surgery, gamma knife radiosurgery can be a first choice of treatment, achieving both growth control and hormonal remission with minimum neurological complications, which is equivalent to conventional radiation therapy but with much less risk of radiation injury to the surrounding structures.     

神经导航在经蝶垂体瘤手术中的应用

目的 探讨神经导航在经蝶垂体瘤术中的应用价值。方法 应用神经导航技术经蝶切除26例垂体腺瘤。术前行三维重建，确定手术入路，术中实时导航，监测肿瘤切除程度。结果 26例垂体瘤在神经导航引导下均能精确定位，肿瘤全切18例，次全切8例；术后7例出现一过性尿量增多，无脑脊液漏和颅内感染，无手术死亡。结论 经蝶垂体瘤手术中，神经导航可提供实时三维定位，有助于提高肿瘤切除率，减少手术并发症。