鼻内镜下经上鼻道进路处理蝶鞍区病变

Treatment of the Diseases in Sphenoidal Sinus and Sellar Area via Trans-superior Meatus Approach under Endoscopy

目的探讨鼻内镜下处理蝶鞍区疾病更直接、安全、微创、有效的手术方法。方法回顾分析1999年8月～2005年1月33例蝶鞍区病变患者接受鼻内镜下经上鼻道进路手术的治疗效果,鞍区病变包括垂体腺瘤20例、蝶窦脑脊液鼻漏7例、视神经管损伤6例。手术时选择患侧或蝶窦发育较好侧鼻腔进行;鼻内镜下切除上鼻甲后半部分,直接暴露蝶窦前壁及开口,扩大开口,经蝶窦打开并扩大蝶鞍区病变部位并处理。结果所有病例均成功地实行了该手术,无严重手术并发症发生;随访1～3年,20例垂体腺瘤中15例全部切除,术后无复发,3例次全切除及2例大部切除者术后配合放射治疗或γ-刀治疗亦带瘤生存;蝶窦脑脊液鼻漏6例修补成功、1例复发;视神经管减压3例显效、2例改善、1例无效。结论鼻内镜下经上鼻道进路处理蝶鞍区病变具有安全、直接、损伤小、恢复快等优点,是治疗蝶鞍区疾病的良好方法之一。

Objective To explore more direct, safe and minimally invasive approach under endoscopy to treat the diseases in sphenoid sinus and sellar area. Methods The curative effectiveness of trans-superior meatus approach under the endoscopy to treat 33 patients suffering from sphenoid sinus and sellar area diseases were retrospectively analyzed from August to January 2005. Of 33 cases, there were 20 cases of piuitary adenoma, 7 cases of cerebrospinal rhinorrhea in sphenoid sinus and 6 cases of optic nerve injury. The anterior wall and ostium of sphenoid sinus were exposed by direct superior turbinectomy under endoscope and the ostium enlarged, and the diseases were treated in sphenoid sinus and sellar area. Results All 33 cases were successfully operated on without serious complications. All cases were followed up for 1-3 years. Of 20 cases of pituitary adenoma, 15 cases obtained entire resection and no recurrence was found; 3 cases obtained subtotal resection and 2 cases partial resection with postoperative radiotherapy and preoperative symptoms were improved. Of 7 cases of cerebrospinal rhinorrhea in sphenoid sinus, repair was successfully performed on 6 cases and recurrence occurred in 1 case. Among 6 cases subject to decompression of optic canal, 3 cases had obvious effect, 2 cases improvement and 1 case inefficacy. Conclusion Treatment of the diseases of the sphenoid sinus and sellar area via trans-superior meatus approach under endoscopy is a safe, direct, minimally invasive, and effective method.