鼻内镜与手术显微镜配合经鼻-蝶窦行垂体瘤手术

Application of combined nasal endoscope and microscope to pituitary adenoma dissection via transnasal-sphenoidal approach

目的 探讨鼻内镜和显微外科技术结合应用于经鼻-蝶窦入路行垂体瘤手术的价值。方法 在全麻下先经一侧鼻孔在内镜下寻找蝶窦开口，在内镜下完全打开双侧蝶窦前壁。蝶嵴上下留一部分残迹，作为中线定位的标志。然后在显微镜下切除垂体腺瘤。结果 36例中30例肿瘤全部切除，6例近全切。术后视野缺损、偏盲、视力减退、泌乳、闭经及头痛等症状均有改善。术后随访1～4年，无复发。结论 采用鼻内镜与显微镜结合应用于经蝶垂体瘤切除术，在内镜引导下具有定位准确，双目显微镜下允许双手操作，可克服各自的缺点，取长补短，并有良好的术野，术后并发症少，符合微创手术原则。

Objective To evaluate the value of combined application of nasal endoscope and microscope to pituitary adenoma dissection via transnasal-sphenoidal approach. Methods Thirty-six patients suffering from pituitary adenomas were operated successfully with combining nasal endosoope and the microscope under general anesthesia. The anterior wall of sphenoid sinus was thoroughly unclosed via right nasal cavity under nasal endosoope. The vestiges of superior and inferior parts of sphenoidal ridge were remained as marks of midline and then the tumors were dissected under microscope which allows binocular vision and bimanual operation. Results Of all 36 patients, the tumors were totally removed in 30 cases and subtotally removed in 6. No postoperative oornplications related to the approach were encountered after following-up 1 to 4 years. All symptoms such as defect of vision field, hemiopia etc were improved. Conclusion Nasal endoscope combined with the microscope have dual advantages of goad sight to the area of the sella, accurate orientation as well as binocular vision and bimanual operation. This technique can also lessen destruction to nasal structures and therefore effect minimal invasion.