单鼻孔经鼻中隔中段入路切除垂体腺瘤的临床观察

Transsphenoidal approach via single natril and middle nasal septum to pituitary adenomas

目的探讨单鼻孔经鼻中隔中段入路切除垂体腺瘤的手术技巧和疗效。方法对68例患者采用单鼻孔经蝶窦入路切除垂体腺瘤,其中巨大腺瘤9例,大腺瘤55例,微腺瘤4例。术中通过鼻中隔中段,即鼻软骨和筛骨垂直板交界部,辨认中线结构。结果手术时间60～180min,平均90min。全切和近全切除61例,大部切除5例,部分切除2例。无手术死亡。结论该入路适宜切除大多数垂体腺瘤,是一种安全、有效、创伤小的手术入路。

Objective To discuss the surgical outcome and operative technique in patients with pituitary adenomas treated by transsphenoidal approach via single natril and middle nasal septum. Methods From February 2004 to July 2005 68 patients with pituitary adenomas had been treated by transsphenoidal approach via single natril. There were 9 macro-adenomas, 55 meso-adenomas and 4 micro-adenomas. During the operation the junction of septal cartilage and perpendicular plate of ethmoid bone was a useful anatomic landmark to identify midline structure. Results The tumors were totally and subtotally removed in 61 cases, large partial removal in 5 cases and partial removed in 2 cases. No death occurred in the serials. Conclusions Transsphenoidal approach via single natril and middle nasal septum is less destructive, with less complications, easy to perform and adapted to the majority of pituitary adenomas.