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本文回顾性比较106例大型垂体瘤的开颅和经蝶手术治疗的比较。开颅组58例,经蝶组48例。开颅组肿瘤次全切除9例,大部切除48例,部分切除1例;经蝶组全切除35例,大部切除12例,部分切除1例。开颅组术后视力好转率71%,无变化12例,恶化3例。手术后偏盲好转率67%;经蝶组手术后视力好转率77%,无变化者11例,无1例恶化。手术后偏盲好转率93%。开颅组20例有额叶挫伤,其中1例并发脑内血肿,死亡4例。作者认为垂体腺瘤不长向鞍旁、海绵窦、前颅窝底和脚间池和肿瘤不呈瓶颈样生长者,都应优先考虑经蝶窦入路手术。
This retrospective comparison of 106 cases of large pituitary tumors craniotomy and transsphenoidal surgery compared. 58 cases of craniotomy group, 48 cases of transsphenoidal group. Subtotal resection in 9 cases of craniotomy group, 48 cases of partial resection, partial resection in 1 case; 35 cases of transsphenoidal resection, most resection in 12 cases, partial resection in 1 case. The rate of visual acuity improvement in the craniotomy group was 71%, no change in 12 cases and deterioration in 3 cases. After surgery, the rate of partial blind improvement was 67%. The improvement rate of visual acuity in the transsphenoidal surgery group was 77%. No change was found in 11 cases and no one was worsened. Postoperative hemianopia improvement rate of 93%. In the craniotomy group, 20 cases had frontal contusion, of which 1 case complicated with intracerebral hematoma and 4 died. The author believes that pituitary adenomas do not grow to the side of the parasellar, cavernous sinus, anterior cranial fossa and the foot pool and the tumor is not bottleneck-like growth, should give priority to transsphenoidal surgery.