Kuwayama A
Nihon Geka Gakkai Zasshi. 1984 Sep;85(9):1014-8.
Microsurgical refinement of classical transsphenoidal pituitary surgery facilitated selective adenomectomy with preservation of normal residual pituitary, thus becoming the first choice in the management of functioning pituitary adenomas. However, lack of tumor capsule and invasive nature of the adenoma make its total removal still difficult. Peritumoral wedge resection is most recommended from our experiences. Surgical results of acromegaly have become quite satisfactory and normal postoperative serum GH levels have been obtained in nearly 100% of the cases with micro or enclosed-adenoma. Pituitary irradiation and/or bromocriptine therapy are, however, yet necessary in half of the cases with marked suprasellar extension or invasion into the surrounding tissues. In the management of macroprolactinoma, surgical excision should precede bromocriptine therapy, because fibrous changes of the adenoma caused by the drug make surgical intervention much difficult. Microprolactinoma can be treated satisfactorily either by surgery or by bromocriptine. Just follow-up observation may be indicated to the cases having no hope for baby. All impaired pituitary functions in Cushing's disease can be converted normal by selective adenomectomy. However, highly qualified microsurgical technique and systematical survey for microadenoma are mandatory, otherwise it is often elusive.
经典经蝶窦垂体手术的显微外科改良有助于在保留正常残余垂体的情况下进行选择性腺瘤切除术，从而成为功能性垂体腺瘤治疗的首选方法。然而，腺瘤缺乏肿瘤包膜以及具有侵袭性，这使得其完全切除仍然困难。根据我们的经验，最推荐进行瘤周楔形切除术。肢端肥大症的手术效果已相当令人满意，在几乎100%的微腺瘤或包膜完整腺瘤病例中术后血清生长激素水平恢复正常。然而，在一半有明显鞍上扩展或侵犯周围组织的病例中，垂体放疗和/或溴隐亭治疗仍然是必要的。在大泌乳素瘤的治疗中，手术切除应先于溴隐亭治疗，因为药物引起的腺瘤纤维化改变会使手术干预变得更加困难。微泌乳素瘤通过手术或溴隐亭治疗均可获得满意疗效。对于没有生育希望的病例，可能仅需进行随访观察。库欣病中所有受损的垂体功能通过选择性腺瘤切除均可恢复正常。然而，必须具备高度熟练的显微外科技术以及对微腺瘤进行系统检查，否则微腺瘤常常难以捉摸。
