神经内镜下经单鼻孔-蝶窦摘除大型垂体腺瘤

Endoscopic endonasal transsphenoidal surgery for large pituitary adenomas

目的 探讨内窥镜辅助下单鼻孔 蝶窦入路摘除大型垂体腺瘤 (LPA)的技术方法与疗效。方法 对 2 0 0 3年 12月至 2 0 0 4年 7月 38例LPA采用内窥镜辅助下经单鼻孔 蝶窦入路技术予以切除。结果 33例 (86 .8% )获全切除 ,3例 (7.9% )达次全切除 ,余 2例 (5 .3% )纤维性或哑铃型腺瘤仅获部分切除。无手术后死亡。 31例 (81.6 % )进行平均 3个月随访观察 ,有 2 9例 (93.6 % )视力获得了恢复 ,仅 2例 (6 .4 % )无变化 ,也未见恶化 ;术前有视野缺损的 30例 ,术后 2 8例 (93.3% )恢复 ,2例(6 .7% )有改善。结论 内窥镜辅助下经单鼻孔 蝶窦入路摘除LPA ,具有微侵袭性、视野全景化、术后并发症少等优点 ,是治疗本病的一种安全、有效的方法。

Objective To evaluate the effect of removing large pituitary adenomas(LPA) by endoscopic technique via endonasal transsphenoidal approach. Methods A total of 38 patients suffering from LPA was performed with endoscopic endonasal transsphenoidal surgery from December of 2003 to July of 2004.Results Gross removal of tumors in 33 cases (86.8%) and subtotal removal in 3 cases (7.9%) were achieved. Partial removal was carried out in the remaining 2 cases (5.3%) with fibrous or dumbbell shaped adenomas. No death was found postoperatively. A median of 3 months' follow up in 31 patients (81.6%) revealed that 29 cases( 93.3% ) with preoperative diminished acuity had got postoperative improvement, no change in 2 cases (6.4%), and none aggravation could be found postoperatively. Among the 30 patients with preoperative visual field defects, postoperative recovery was achieved in 28 cases (93.3%) and improvement in 2 cases (6.7%). Conclusion Featured by perfect surgery vision, minimal invasion and less postoperative complications, endoscopic technique via endonasal transsphenoidal apporoach is a safe and effective method for the treatment of LPA.