Surgical Multimodality Treatment Of Pituitary Adenomas(about Analysis Direct Transnasal Transsphenoidal Approach For 120 Pituitary Adenomas)

Objective: To analysis the superiority of direct transnasal transsphenoidal approach for 120 pituitary adenomas.The surgical multimodality treatment can help diagnosis, raising the cure rate, reducing the rate of complications and the recurrant rate, improving the social psychological adaptation of patients.Method: 120 inpatients were chosen to review from January 1st 2004 to November 1st 2006 in the First Hospital of Jilin university,that had been diagnosed as pituitary adenomas by pathology, and whose clinical dating were complete. Each patient has received MRI and pituitary function examination. All of them have received the direct transnasal transsphenoidal approach surgery, performed by a same surgeon. 12 pituitary adenomas of them received transforehead opration.8 cases received transpterional opration. Three groups are compared on surgery time, effect after opration, the complications and so on.Result: There is no case of death among 120 patients. The rate of total excision is about 90%, 57 cases in 63 patients got their vision and view improving. The rate of the improvement is about 91%. All of the transforehead surgery and the transpterional surgery group members Had the vision and view problem, 13 of them improved after operation, p<0.05, it is statistical. The level of the hormone reduced in 18 cases, that ever had endocrine disorder, and 7 cases reduced to normal. The two men, who had sexual dysfunction, have marked improvement postopration. 26 cases got complications after surgery,which referred 37 person-time.It accout for about 22%, which including 18 cases of diabetes insipidus, occupy 49%, 8 cases of cerebrospinal fluid leaking, occupy 21%. 7 cases of electrolyte disorder, occupy 19%.1 case of fate, occupy 3%. 2 cases of lung infection, occupy 5%.1 case of injured of oculomotor nerve, occupy 3%. 22 cases of them were recovered when leaved hospital. There are 26 in 120 patients had the complication, 9 of the control group members had the complications, p<0.05, it is statistical .The longest period in hospital cost 26 days, the shortest is 6 days, the average period is 10 days. 28 patients were followed up, 19 cases in them followed the doctor's advice, who received the radiotherapy one month after surgery and had no evidence of recurring. 21 cases in the 28 patients did not recur after one year, there is only 1 in 7 cases recurred.Discussion: The incidence of the pituitary adenoma shows that the morbility has an increasing tendency recently. Most pituitary adenoma should be performed operation as early as possible, except some PRL micro-adenoma can be therapied by medicine taking. Make sure total excision of the tumor to avoid the later injury. The surgery therapy is coming to the micro-injury period, and the direct transnasal transsphenoidal approach is becoming the standard mould .It has the virtues such as harmless, soon recovery, abridging the approach to surgery region, avoid injury of the important nerve and blood vessels,less bleeding, hidden incision, no injury of the oral mucosa, eating from mouth as soon as possible. The pituitary adenoma is a systemic disease, which need the complete surgery multimodality treatment. It includes the standard management, the imagine examination and the pituitary function examination, diagnosis and location correct, health education and preparation before operation. The performer should have good knowledge and experienced, taking good care after operation, monitoring the patient carefully. All of them can increase the recovery rate, reduce the death rate and complication, improving the social psychological adaptation of patients.