论文部分内容阅读
目的探讨分析鞍区占位尤其是经蝶手术者术后出现视力减退的原因。方法回顾性分析近10年来我科显微外科手术治疗的276例鞍区占位患者,分别采用经蝶入路、经额下入路、经翼点入路、经纵裂胼胝体入路切除肿瘤,显微镜下对术野能达到的地方力争全切肿瘤。结果所有患者手术后均有MRI或者CT复查资料,其中全部切除者179例,占64.9%,大部分切除者81例,占29.3%,部分切除者16例,占5.8%;经蝶入路手术者术后视力下降3例(3/45例),其中颅咽管瘤1例,垂体瘤2例,均为实质性肿瘤,经额下入路手术者术后视力下降8例(8/67例),经翼点入路手术者术后视力下降25例(25/147例);术后单侧视力下降者22例,占所有患者的8%,其中右侧视力下降者16例,占所有患者的5.8%,双侧视力下降者14例,占所有患者的5%;视野缺损(双颞侧偏盲)加重者6例;这36例视力下降者,27例(75%)经3个月~8年的随访,视力均无明显改善。结论鞍区肿瘤术后出现视力下降的原因可能有,①、术中损伤视神经,②、术中电凝止血时阻断了视神经的供血动脉,③、缺血再灌注损伤。
Objective To investigate the causes of postoperative visual acuity after occupying the saddle area, especially the transsphenoidal surgery. Methods A retrospective analysis of 276 cases of sellar space occupying patients undergoing microsurgery in the past 10 years were retrospectively analyzed. The patients underwent transsphenoidal approach, transabdominal approach, pterional approach, , Under the microscope to reach the surgical field and strive to cut the tumor. Results All the patients had MRI or CT data after operation, of which 179 cases were resected, accounting for 64.9% of the total resection, 81 cases were mostly resected, accounting for 29.3%, 16 cases were partial resection (5.8%); transsphenoidal surgery The postoperative visual acuity decreased in 3 cases (3/45 cases), including 1 case of craniopharyngioma and 2 cases of pituitary tumor, all of which were solid tumors. The patients’ eyesight decreased after surgery (8 cases) (P <0.05) .After operation of pterional approach, the visual acuity decreased 25 cases (25/147 cases); 22 cases of unilateral visual acuity decreased after surgery, accounting for 8% of all patients, of which 16 cases of right vision loss in 16 cases All patients had 5.8%, bilateral vision loss in 14 cases, accounting for 5% of all patients; visual field defects (bilateral temporal hemianopia) increased in 6 cases; 36 cases of decreased visual acuity, 27 cases (75%) after 3 Months to 8 years of follow-up, no significant improvement in visual acuity. Conclusions There may be causes of postoperative visual acuity decline in the sellar region. ① The optic nerve is damaged intraoperatively, ② The blood supply artery of the optic nerve is blocked during the electrosurgical hemostasis. ③ The ischemia-reperfusion injury is prevented.