单鼻孔经蝶入路切除垂体腺瘤并发症的预防与治疗

Complication and management of the transnaso sphenoidal approach to pituitary adenoma

目的探讨单鼻孔经蝶窦显微手术治疗垂体腺瘤的并发症及其防治。方法对116例垂体腺瘤患者采用单鼻孔经蝶入路显微镜直视下肿瘤切除手术,其中垂体微腺瘤17例,大腺瘤89,巨大腺瘤10例。结果本组共发生各类型的并发症21例,发生率18.1%,其中脑脊液鼻漏7例,尿崩症5例,术后视觉障碍3例,垂体功能不足、外展神经麻痹、鼻出血各2例。大部病人都经保守治疗而愈。结论单鼻孔经蝶入路切除垂体腺瘤手术并发症多与手术操作有关,熟悉局部显微解剖及良好的手术技巧可降低并发症的发生。

Objective To explore the complication and management of the transnaso- sphenoidal microsurgery to pituitary adenoma. Methods 116 cases of pituitary adenomas were removed by the transnaso-sphenoidal approach under operative microscope, of which there were 17 microadenoma patients; 89 macroadenoma patients; 10 giant pituitary adenoma patients. Results After the operation, a series of 21 complication and management were reported. The rate of complication was 18. 1 %, of which there were 7 CSF rhinorrhea patients; 5 diabetes insipidus patients; 3 visal disturbance patients; 2 supsecreting patients; 2 abduct nerve paise patients; 2 nasal bleeding patients. 19 cases had been cured by the non--operation. Conclusion The complication was related with the operative procedure. The master of the local microdisscetion and the proficient operation skill can decrease the rate of complication.