经单鼻孔蝶窦入路显微镜下切除垂体腺瘤

Single-nostril transsphenoidal microscopic pituitary adenoma surgery

目的探讨经单鼻孔蝶窦入路显微镜下切除垂体腺瘤的手术方法和疗效。方法对28例垂体腺瘤的病人采用经单鼻孔蝶窦入路行显微镜下垂体腺瘤摘除术,其中微腺瘤18例,大腺瘤10例;功能腺瘤20例,其中催乳素瘤10例、生长激素腺瘤5例、促肾上腺皮质激素腺瘤3例、促性腺激素腺瘤2例;无功能腺瘤8例。结果显微镜下全切除肿瘤20例,次全切除5例,大部分切除3例;术后无1例死亡,无脑水肿、视神经损伤、鼻中隔穿孔以及鼻腔粘连等并发症;术后所有病人血清激素水平均较术前有明显下降,随访3～6个月,未见影像学下的肿瘤复发。结论显微镜下经单鼻孔蝶窦入路切除垂体瘤具有鼻腔结构损伤小、术后并发症少、病人恢复快等优点。

Objective To introduce the operative methods and results of single-nostril transsphenoidal microscopic pituitary adenoma surgery. Methods 28 patients were treated through the single-nostril transsphenoidal microscopic pituitary adenoma surgery. The patients were distributed in 18 microadenomas, 10 macroadenomas, or 20 hormone-secreting adenomas, 8 nonsecreting adeonomas. Results 20 adenomas were totlally resected, 5 subtotally resected and 3 largely resected. There was no mortality and recurrence in this series. Cerebraledema, optic nerve injury, and nasal septum perforation were not found. Three cases of temporary cerebrospinal rhinorrhea occurred and recovered by active treatment. Headache and visual disturbance were cured or improved and the increased hormone level were decreased to normal postoperatively. Conclusion The single-nostril transsphenoidal microscopic pituitary adenoma surgery can offer less injury of nasal structures and total or subtotal resection of tumor without severe complications. Patients recover quickly.