经单鼻孔蝶窦入路显微手术切除垂体腺瘤

Single-nostril transsphenoidal pituitary adenoma microsurgery

目的介绍经单鼻孔蝶窦入路显微手术切除垂体腺瘤的初步经验和体会。方法对45例垂体腺瘤患者采用经单鼻孔蝶窦入路显微手术切除,微腺瘤6例,大腺瘤39例;其中PRL腺瘤10例,GH腺瘤5例,混合性(PRL+GH或PRL+ACTH)腺瘤27例,无功能性腺瘤2例。结果2例因蝶窦发育及鞍底解剖形态异常行术中形臂定位,其余病例显露满意;术后一过性尿崩10例,经治疗一周左右恢复。无死亡、脑出血、脑脊液鼻漏及颅内感染等并发症。术后平均住院7d,全组病例术中未输血;最长病例跟踪随访3年未见复发。结论单鼻孔经蝶窦入路较传统经蝶入路具有操作快捷、鼻腔结构损伤小、并发症少及术后恢复快等优点。

Objective To introduce the experience of microsurgery of pituitary adenoma via single-nostril transsphenoidal approach. Methods 45 patients with pituitary adenoma were treated with the sing le-nostril transsphenoidal microsurgery. The patients were consisted of 6 micro adenomas and 39 macroadenomas. There were 10 PRL-adenomas, 5 GH-adenomas, 27PRL-GH or PRL-ACTH adenomas and 2 nonsecreting adenomas. Results No one died in this series. Cerebral hemorrhage,cerebrospinal rhinorrhea and intracranial infection were not found. Ten cases presented acute temporary disbetes insipidus. Mean length of hospitalization for postoperation was 7 d. Conclusion The single-nostril transsphenoidal pituitary adenoma surgery has less injury of nasal strures and nosevere complications.