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目的:分析经额底纵裂入路治疗鞍上第三脑室底垂体瘤的疗效,探讨其临床适用性。方法:选择从2011年1月~2013年1月与我院行额底纵裂入路手术治疗的30例鞍上第三脑室底垂体瘤的患者,术中行单侧额或双侧额弧形切口,根据术中所见肿瘤位置,由终板、视神经一颈内动脉等存在的生理间隙处切除肿瘤,观察所有患者的手术疗效。结果:所有患者术中可见肿瘤位于鞍内鞍上,部分或全部突入第三脑室底,其中有6例患者伴有脑积水。术中肿瘤全切23例,次全切5例,大部切除2例,无手术死亡病例。术前25例患者视力减退,术后23例患者视力均获得不同程度改善,仅1例暂无明显变化。术后19例出现电解质紊乱,患者经治疗后均已纠正;12例出现不同程度的尿崩症,给予患者药物治疗后,病情得到缓解。术后随访6个月,23例肿瘤全切患者病灶无复发,另外4例次全切者病灶也无明显变化,仅1例次全切和2例大部切除患者于术后行伽马刀再次治疗。结论:经额底纵裂入路治疗鞍上第三脑室底垂体瘤可以达到视野清晰,直观下进行肿瘤切除,手术效果好,并发症较少,适合临床长期推广应用。
Objective: To analyze the curative effect of basal longitudinal split approach on the third ventricle pituitary tumor in the suprasellar saddle, and to explore its clinical applicability. Methods: From January 2011 to January 2013 in our hospital with the line of longitudinal incision approach surgery in 30 cases of supraspinatus third ventricle pituitary adenomas in patients with unilateral or bilateral forehead arc surgery Incision, according to the location of the tumor seen in the surgery, the endplate, the optic nerve - internal carotid artery and other existing physiological clearance at the tumor removal, observation of the efficacy of surgery in all patients. Results: All patients showed tumor located in the saddle in the saddle, some or all into the third ventricle, including 6 patients with hydrocephalus. Totally 23 cases of intraoperative resection of the tumor, subtotal resection in 5 cases, most of the resection in 2 cases, no surgical deaths. Preoperative 25 patients with visual acuity decreased, 23 patients after visual acuity were improved to varying degrees, only 1 case no significant change. Electrolyte disorder occurred in 19 patients after operation. All patients had been corrected after treatment. Diabetes insipidus was found in 12 patients with different degrees of diabetes insipidus. The patients were relieved after drug treatment. All patients were followed up for 6 months. Twenty-three patients with complete resection had no recurrence, and the other four cases did not show any significant changes. Only one subtotal and two subtotal resections underwent gamma knife Again treatment. Conclusion: The treatment of third basal pituitary tumors on the suprasellar fissure can achieve a clear visual field and intuitive tumor resection. The operative effect is good and the complication is less, which is suitable for long-term clinical application.