内镜辅助显微镜经鼻蝶入路垂体腺瘤切除术应用解剖及临床研究

Anatomical Observation and Its Clinical Application in Removing Pituitary Adenomas through Endoscope - assisted Endosnasal Transsphenoidal Approach

目的：探讨内镜辅助显微镜经鼻蝶入路的解剖与临床应用价值。方法：在6例成人尸头标本上模拟经鼻蝶入路手术。采用内镜辅助显微镜经鼻蝶入路手术治疗垂体瘤患者32例。结果：（1）采用经鼻蝶入路，内镜下在蝶窦内可观察到更多的周围结构，利于确定鞍底、海绵窦与鞍结节位置，在显露硬膜下结构时，内镜下侧方可显露海绵窦外侧壁，前方可显露双侧嗅神经和直回。（2）32例患者中，肿瘤全切29例，次全切除2例，大部切除1例；无手术死亡病例，无严重并发症发生。结论：内镜辅助显微镜经鼻蝶入路对鞍区显露良好、肿瘤全切率高、手术创伤小、术后并发症少，是切除垂体瘤的理想术式。

Objective：To investigate the microanatomy related to endonasal transsphenoidal approach under endoscope and evaluate clinical application of this approach. Methods：The operation via an endonasal transsphenoidal approach under endoscope was imitated on 6 adult cadaveric heads and performed on 32 cases with pituitary adenoma. Results：In sphenoid sinus, more surrounding structures were ohserved under endoscope through endosnasal transsphenoidal approach, seflar floor, cavernous sinus and tuberculum sellae were determined easily. To expose subdural structures, lateral wall of cavernous sinus in lateral, olfactory nerves and rectal gyri in front were revealed under endoscope. Total resection of tumor was achieved in 29 cases, subtotal resection in 2 and partial excision in 1. No postoperative severe complication occurred. Conclusions：The operation via an endonasal transsphenoidal approach under endoscope could clearly reveal saddle region. This approach has advantages of higher total removing rate, little surgical trauma, and fewer complications, is a preferential method for removing hypophysoma.