鼻内镜下鼻蝶入路垂体腺瘤显微切除术(附19例报告)

Micro-resection of pituitary adenoma through endoscopic transseptal transsphenoidal approach(a report of 19 cases)

目的探讨鼻内镜下鼻中隔蝶窦入路垂体腺瘤切除术的方法及并发症的防止.方法唇龈沟切口鼻内镜下经鼻中隔蝶窦径路显微切除垂体腺瘤19例,16例微腺瘤施行全切,3例大腺瘤行囊内次全切除并用无水酒精烧灼,全部病人用唇筋膜和鼻中隔骨片重建鞍底.结果肿瘤全切除16例,次全切除3例.7例术前视力损害者6例得到不同程度的恢复,所有病例症状改善,术后除1例视力一过性减退和2例嗅觉一过性减退外,其余病例均无脑脊液漏和脑膜脑膨出等并发症.术后随访3～36个月,16例肿瘤无复发,3例次全切除者肿瘤生长缓慢.结论鼻内镜唇下-鼻中隔-蝶窦入路是切除垂体腺瘤的较理想径路,术中囊内烧灼可有效地防止或减缓术后肿瘤复发,术后唇筋膜和鼻中隔骨片重建鞍底可防止相应并发症.

Objective To evaluate the endcscopic transseptal transsphenoidal approach for treatment of pituitary adenoma. Methods Nineteen patients with pituitary adenoma were treated by microsurgery through endoscopic transseptal transsphenoidal approach, including 16 with total and 3 with subtotal resection of the tumor mass, The sphenoid-saddle base was reconstructed with lip fascia and nasal septum bone in all cases. Results There were no surgical complications except one with visual and two with olfactory discrimination transient decrease. Six out of 7 patients with vision defect had different degrees of recovery after surgery. All patients were followed-up for 3 to 36 months. There was no recurrence in all cases with total tumor resection, Conclusion The endoscopic transseptal transsphenoidal approach is an effective method for micro-resection of pituitary adenoma. Reconstruction of sphenoid-saddle base with lip fascia and nasal septum bone is useful to prevent severe complications.