经蝶垂体腺瘤手术后残留原因分析

The reasons for residual of pituitary adenoma after trans-sphenoid operation

  • 摘要: 目的: 探讨经蝶切除垂体腺瘤手术后残留的原因,提高治疗效果; 方法: 回顾性分析自1992年10月至2003年1月,在我院及外院经蝶手术治疗后,MRI检查证实仍有残留的118例垂体腺瘤。结果: 肿瘤主体残留在海绵窦占4 6.6%,鞍内37.3%,鞍上5.1%,混合9.3%,颅外1.7%;影响肿瘤根除的主要因素,肿瘤侵袭海绵窦4 6.6%,术者经验不足36.4%,肿瘤侵润生长9.3%,肿瘤体积巨大3.4%,出血多4.2%。针对残余瘤组织再手术者为10.1%,普通放射治疗39.0%,г刀治疗38.2%,药物治疗11.0%。结论: 经蝶手术残瘤的主要原因是肿瘤侵袭海绵窦,这些病例不能或很难单纯手术根除;其次是术者经验不足和技术问题而造成。在有残瘤的病例中,有半数以上病例可以通过提高技术水平达到肿瘤的全切或次全切除。

     

    Abstract: Objective: To explore the reasons of residual of pituitary adenoma after trans-sphenoid operation and to improve the effect of treatment. Methods: Retrospectively analysis 0f 118 consecutive cases of MRI convinced residual pituitary adenoma after trans-sphenoid operation both in our hospital and in other hospitals from October 1992 to January 2003. Results: The majority of the residual tumor tissue are located in cavernous sinus(CS)(46.6%),sella tursica (37.3 %),supra sella (5.1%),mixed(8.3%) and extra-cranial (1.7%);The main reasons that hinder radical removal are tumor involve cavernous sinus(46.6%),less experience operator (36.4%),tumor invasively growing (9.3%),huge tumor (3.4%)and heavy bleeding (4.2%).Treatment for the residual tumor includes re-operation 10.1%,linear accelerator-radiation treatment 39.0%,г-knife 38.2%,medication treatment 11.0%. Conclusion: The main reasons of residual for pituitary adenoma after trans-sphenoid operation is tumor involving cavernous sinus. These tumors can not or are very difficult to be radically removed simply by operation. The second reason is less experience and technical problem. Over half of the residual tumors could be totally or sub-totally removed through improved technique.

     

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