Sudhakar N, Ray A, Vafidis J A
Department of Neurosurgery, University Hospital of Wales, Cardiff, UK.
Br J Neurosurg. 2004 Oct;18(5):507-12. doi: 10.1080/02688690400012459a.
The incidence of surgical complications after trans-sphenoidal surgery for pituitary lesions is low. The influence of size of the lesion and its pathology on the incidence of different types of complications and the remission rate of functioning adenomas are addressed in this retrospective study. Between 1996 and 2001, 126 trans-sphenoidal operations were performed on 108 patients with pituitary pathologies. Diabetes insipidus (DI) was the commonest (23%) and the incidence was higher with microadenomas and in those with Cushing's disease (p < 0.05). Other important complications were: postoperative hypopituitarism 22%, CSF leak 13%, meningitis 5.5%, pneumocephalus 2.4%, visual deterioration 1.5%, haematoma 0.8% and 30-day mortality rate of 0.8%. Other complications encountered were subdural haematoma, epistaxis, SIADH, sphenoid abscess, deep vein thrombosis, thalamic infarct and hydrocephalus. No vascular injuries were encountered. The overall remission rate for acromegaly and Cushing's disease (22 patients each) was 77 and 81%, respectively. The remission rate was 100% for microadenomas, 89% for both acromegaly and Cushing's disease. More aggressiveness towards complete tumour removal increases the biochemical cure rate of functioning adenomas and on the other hand results in higher incidence of CSF leak and hypopituitarism.
经蝶窦手术治疗垂体病变后手术并发症的发生率较低。本回顾性研究探讨了病变大小及其病理对不同类型并发症发生率以及功能性腺瘤缓解率的影响。1996年至2001年间，对108例垂体病变患者进行了126次经蝶窦手术。尿崩症（DI）最为常见（23%），微腺瘤患者以及库欣病患者的发生率更高（p < 0.05）。其他重要并发症包括：术后垂体功能减退22%、脑脊液漏13%、脑膜炎5.5%、气颅2.4%、视力恶化1.5%、血肿0.8%以及30天死亡率0.8%。还遇到了其他并发症，如硬膜下血肿、鼻出血、抗利尿激素分泌异常综合征（SIADH）、蝶窦脓肿、深静脉血栓形成、丘脑梗死和脑积水。未发生血管损伤。肢端肥大症和库欣病（各22例）的总体缓解率分别为77%和81%。微腺瘤的缓解率为100%，肢端肥大症和库欣病均为89%。更积极地追求肿瘤完全切除可提高功能性腺瘤的生化治愈率，但另一方面会导致脑脊液漏和垂体功能减退的发生率升高。
