经蝶窦行鞍区肿瘤手术入路探讨

THE TRANSNASOSEPTAL-SPHENOIDAL SURGICAL APPROACH FOR INTRASELLER TUMORS

报告84例经鼻中隔,蝶窦入路摘除蝶鞍区肿瘤手术方法及效果。术前检查有单纯性鼻炎2例,过敏性鼻炎2例;鼻中隔C型弯曲或嵴突32例;全鞍型蝶窦79例,甲介型5例;蝶鞍正常53例,扩大者31例,其中鞍底有破坏的占12例。鞍内肿瘤病理诊断,垂体腺瘤81例,垂体囊肿1例,颅咽管瘤2例。经鼻小柱-鼻中隔-蝶窦行鞍内肿瘤手术,暴露病灶清楚、准确,并发症少,效果良好,无1例死亡。作者认为鼻中隔软骨保留,筛骨垂直板及犁骨仅部分去除,可以减少并发症。术后随访2个月～5年,合并症仅鼻中隔穿孔1例,鼻中隔血肿1例,鼻腔粘连2例,鼻窦炎4例,一过性尿崩症9例,均经治疗后痊愈。

The transnasoseptal-sphenoidal sinus surgical technique and results in 84 cases of int-rasellar tumors are reported. In the preoperative examination, there were two cases of chronic rhinitis, two cases of allergic rhinitis, 32 deviation or ridge of the septum, 81 cases of completely pneumatized sphenoid sinus (sellar type), five of conchal type, 53 of the normal sellar turcica, 31 of the enlarged sellar, and 12 of the 31 cases had destructive sellar floor. In the intrasellar tumors, pathological diagnosis showed: 79 pituitary adenomas, one pitujtary cyst and two craniopharyngiomas. The advantage of the columolla-naso-septal-sphenoid sinus route is discussed. The operative approach may achieve accuracy in a clearly exposed focus, seldom complicated, no mortality, and favorable outcomes. This study suggests that care must be taken that the septal cartilage is only removed partly, neither the perpendicular plate of the ethmoid bone and the vomer during the procedure, in order to prevent and reduce complications. All of the cases have been followed for a period ranging from 2 months to 5 years postoperatively. In only one case was there a perforation of the septum, one of nasoseptal hematoma, two of ankylorrhinia, four naso-sinusitis and in nine temporary diuresis. The others recovered completly.