鼻内镜联合显微镜经鼻腔蝶窦及中颅窝手术

Transnasal operations on the sphenoidal sinus and the middle fossa under nasal endoscope combined with microscope

目的探讨鼻内镜下经鼻腔直接入路行蝶窦及中颅窝手术的方法。方法鼻内镜下经较宽大一侧鼻腔将中鼻甲向外推移,鼻腔扩张器扩大视野,直达并开放蝶窦前壁,鼻内镜与显微镜联合切除病变。结果10例孤立性蝶窦炎术后症状消失。6例蝶窦囊肿、脑膜瘤均一次手术切除。32例垂体腺瘤17例全切除,12例次全切除,3例大部分切除,术后补充X刀治疗。48例术后随访6个月～3.5年,平均2.5年,蝶窦囊肿、蝶窦炎、脑膜瘤无复发,3例垂体腺瘤复发,无颅内感染并发症,无鼻腔粘连、鼻出血等鼻腔并发症。结论鼻内镜联合显微镜经鼻腔蝶窦及中颅窝手术损伤小、出血少、手术时间短、效果好。

Objective To investigate the surgical method of transnasal operations on the sphenoidal sinus and the middle fossa under nasal endoscope combined with microscope. Methods The operation was performed under nasal endoscope on the side of larger nasal cavity. The middle nasal turbinate was pushed outwards. Then the Handy＇ s expander was inserted between the middle nasal turbinate and the nasal septum in order to get a wide visualization. The sphenoidal frontal wall was opened directly. The nasal endoscope and microscope were utilized in turn to complete the resection of lesions. Results The symptoms disappeared postoperatively in 10 cases of solitary sphenoidal sinusitis. The lesions of 6 cases of sphenoidal cyst and meningioma were all surgically removed on one session. Among 32 cases of pituitary adenoma, a total resection was carried out in 17 cases, a subtotal resection in 12 cases, and a partial resection in 3. After surgery, a supplemental X - knife radiosurgery was employed. Postoperative follow - up in the 48 cases for 0.5 - 3.5 years （ mean, 2.5 years） showed no recurrence of sphenoidal cyst, sphenoidal sinusitis, or meningioma, and 3 cases of recurrence of pituitary adenoma. No intracranial infection, adhesion of nasal cavity, or nasal bleeding was noted. Conclusions Transnasal operations on the sphenoidal sinus and the middle fossa under nasal endoscope combined with microscope has advantages of mild invasion, little blood loss, short operation time, and good outcomes.