经单鼻孔蝶窦入路神经内镜下手术治疗垂体腺瘤

Single-nostril Transsphenoidal Endoscopic Pituitary Adenoma Surgery

背景与目的:随着微侵袭神经外科的发展,神经内镜在神经外科的应用范围日趋广泛。本研究的目的是探讨神经内镜下经鼻蝶入路手术治疗垂体腺瘤的疗效。方法:对300例垂体腺瘤患者采用神经内镜下经鼻蝶入路垂体腺瘤切除术。其中微腺瘤60例,大腺瘤228例,巨型腺瘤12例。观察疗效及并发症。结果:肿瘤全切255例,近全切32例,大部分切除13例;无死亡病例;无严重并发症发生。术后随访3～12个月,原有症状均有明显改善,术前异常增高的激素水平均降至正常。MRI检查显示无肿瘤复发。结论:在神经内镜下经单鼻孔蝶窦入路垂体腺瘤切除术具有深部照明好,鼻腔结构损伤小,切除肿瘤彻底,术后并发症少,恢复快等优点。

BACKGROUND ＆ OBJECTIVE： The application of the neuroendoscope in neurosurgery is expanding. The aim of the article was to explore the safety and effectiveness of the single-nostril transsphenoidal endoscopic approach in the treatment of pituitary adenomas. METHODS： Three hundred patients with pituitary adenomas were treated through single-nostril transsphenoidal endoscopic approach. Microadenomas were found in 60 cases, macroadenomas in 228 cases and huge adenomas in 12 cases, respectively. RESULTS： Among 300 patients, total removal was achieved in 255 cases, subtotal removal in 32 cases and major removal in 13 cases. No mortality was observed in this series of patients. No severe complication was found. With 3-12 months＇ follow-up, the symptoms of headache and visual disturbance were cured or improved. The increased hormone level decreased to the normal postoperatively. There was no recurrent case. CONCLUSION： The single-nostril transsphenoidal endoscopic pituitary adenoma surgery offers an increased illumination and magnification during operation, as well as less injury of nasal structures. This approach is safe and efficient to remove adenomas completely without severe complications.