内镜下经单鼻孔蝶窦人路垂体腺瘤切除术的临床应用（附39例报告）

Endoscopic Endonasal Pituitary Surgery Surgical and Outcome Analysis of 39 Cases

目的：总结神经内镜下经单鼻孔蝶窦人路切除垂体腺瘤的经验及体会。方法：采用内镜下经单鼻孔蝶窦入路垂体腺瘤切除术治疗患者39例，其中微腺瘤13例，大腺瘤20例，巨大腺瘤6例。术后接受放疗28例。结果：肿瘤全切除20例（51．3％），次全切除8例（20．5％），大部切除5例（12．8％），部分切除6例（15．4％）。术后出现一过性尿崩症4例，脑脊液鼻漏合并颅内感染1例，双目失明1例。随访3个月～3a，视力视野改善31例，肿瘤复发5例。结论：内镜下经单鼻孔蝶窦入路手术治疗垂体腺瘤，具有创伤小、深部照明好、术野清晰、操作方便、并发症少等优点，手术疗效好，患者恢复快。

Objective：To sum up the author＇s experience and understandings in the resection of pituitary adenoma by the endoscopy-assisted single-nostril transsphenoidal approach. Methods：Thirty nine patients with pituitary adenomas had been treated through the endoscopic single-nostril transsphenoidal operation, including 13 microadenamas, 20 macroadenomas and 6 huge adenomas. Twenty eight patients received postoperative radiotherapy. Results：Twenty cases received total resection of pituitary adenomas （51.3%） , 8 subtotal （20. 5% ）, 5 greatly partial （ 12.8% ） and 6 partial （ 15.4% ） ; After operation, 4 cases suffered from transient dia- betes insipidus, one cerebrospinal rhinorrhea and intracranial infection and one losed his eyesight. The patients were followed up for 3 months to 3 years after the operations. 31 patients gained improvement with visual acuity and visual field and 5 patients had a tumor recurrence. Conelusions：The endoscopic single-nostril transsphenoidal approach for resection of pituitary adenoma has many merits including minimal surgical trauma, fine deep illuminating, clear field of operation, convenient manipulation and less complications. It produces good therapeu- tic effects and promotes fast recovery of patients.