鼻窦镜辅助下经单鼻孔入路垂体腺瘤显微手术切除

Endoscope-assisted endonasal transsphenoidal pituitary adenomam icrosurgery

目的 总结鼻窦镜辅助下经单鼻孔入路垂体瘤显微手术切除术的经验及初步体会。方法鼻窦镜辅助下 ,经单侧鼻腔 ,严格中线入路打开蝶窦前壁 ,暴露鞍底。然后在神经显微镜下行垂体瘤切除 ,最后鼻窦镜下鞍底重建。结果 2 1例患者中 16例一次手术全切除 ,3例次全切除 ,1例巨大生长激素 (growthhormone ,GH)腺瘤大部分切除 ,后经改良翼点入路二次手术切除 ,1例巨大催乳素(prolactin ,PRL)腺瘤分 2次经蝶肿瘤切除 ,术后患者症状均改善。尿崩 2例 ,分别于术后 7d、15d停止 ;脑脊液漏 1例 ,保守治疗 2周治愈。结论 耳鼻喉科医师解剖熟悉 ,鼻窦镜下显露鞍底准确充分 ,神经外科医师显微镜下可克服内镜单手操作的不便 ,二者结合有利于减少经单鼻孔入路垂体瘤切除的创伤 ,提高安全性 ,是一种有效的方法。

Objective With reviewing our primary clinical expe ri ence with the endoscope-assisted endonasal transsphenoidal pituitary adenom a microsurgery, to discuss the techniques and its advantages. Methods The anterior wall of the sphenoid sinus was opened strictly along the mi ddle-line and the sellar floor was exposed with the assistance of endoscope thr ough one nostril. Then the tumor was resected under neurosurgical microscope . Finally, the sellar floor was reconstructed under endoscope.Results Of 21 patients, tumors were totally removed in 16 cases, and subtotal ly resected in 3 cases. A growth hormone-secreting pituitary macroadenoma w as partially resected using this approach and then totally removed through a mod ified pterional approach surgery. Another patient with macroprolactinoma receive d operations twice with this approach and achieved total tumor removal. Symp toms of the patients were all improved. Two patients developed postoperative dia betes insipidus and recovered 7 d and 15 d after surgery, respectively. Cerebros pinal fluid leakage occurred in one patient and was cured with conservative treatment in 2 weeks. Conclusion Otolaryngologists, familiar wi th the anatomy of the sphenoidal sinus, can expose the sellar floor precisely an d sufficiently. While neurosurgeons operate under microscope to overcome the inconvenience of single-handed operation with endoscope. The endoscope -assisted endonasal transsphenoidal pituitary adenoma microsurgery is a minimal invasive, safe and effective technique.