经单鼻孔-蝶窦入路显微手术切除垂体腺瘤的理论与实践

THEORY AND PRATICE OF SINGLE - NOSTRIL TRANSSPHENOIDAL APPOACH FOR MICROSURGICAL REMOVAL OF PITUITARY ADENOMAS

目的:探讨经单鼻孔-蝶窦入路显微手术切除垂体腺瘤的科学性和实用技术技巧。方法:报告手术治疗42例大型、巨大型腺瘤,分析所遇到的问题和手术技术改进过程,结合文献讨论技术要点。结果:肿瘤全切除32例,次全切除4例,大部切除5例,部分切除1例。85.7%出现术后尿崩,个别出现迟发性鼻腔出血。结论:经单鼻孔入路属于新型的徽创手术,虽然通道狭小,但只要操作适当,不论鼻孔大小如何均可安全实施该手术,但要注意鼻腔的止血和定位的准确性。

Objective: To explore the science and technique of single - nostril transsphenoidal approach for microsurgical removal of pituitary adenomas. Method: Microsurgical operations were performed on 42 cases of large or giant pituitary adenomas. The problems encounted in surgical removal and improvement of technique were analysed, and operative details were discussed with review of the relevant literature. Results: Total removal of the tumor was achieved in 32 cases, subtotal removal in 4 cases and partial removal in 6 cases. Diabete insipidus appeared in 36 cases (85.7%), and delayed epistaxis in individual case. Conclusion: Single -nostril approach is a newly minimally invasive surgery. Despite the narrow channels provided by nostril size, it all can be adopted for patients with pituitary adenomas. Manage of epistaxis and accurate location of nasal cavity should be noticed.