内镜下经单鼻孔蝶窦入路垂体瘤切除术的改良手术配合

Modification of the surgical instruments for endoscopic pituitary tumor resection through the endonasal transsphenoidal approach

目的 通过手术器械的改进与应用,提高神经内镜下经鼻蝶入路垂体瘤切除术的手术效率,总结手术配合的经验.方法 南方医科大学南方医院神经外科自2004年3月至2009年4月采用经单鼻孔鼻中隔蝶窦入路切除垂体瘤288例,术前改进各种手术器械（单极电凝器、吸引器的形状和功用）并应用,总结分析手术的疗效.结果 本组垂体瘤全切除204例,次全切54例,大部分切除30例.手术时间最短30 min,术中无脑脊液漏患者手术时间平均70 min;术后并发脑脊液漏3例,鼻黏膜迟发性出血3例,经治疗后控制.结论 手术器械的改进与正确应用,加上默契的手术配合,可以提高神经内镜下经单鼻孔鼻中隔蝶窦入路垂体瘤切除术的效率.

Objective To modify the surgical instruments to improve the efficiency of endoscopic pituitary tumor resection through the endonasal transsphenoidal approach and sum up the surgical experiences. Methods Two hundred and eighty-eight patients with pituitary tumor were performed endoscopic tumor resection through the endonasal transsphenoidal approach in our hospital from March 2004 to April 2009; modification of the surgical instruments （monopolar coagulator,aspirator＇s shape and function） was applied. The efficiency of the surgery was concluded and analyzed.Results Total tumor resection was achieved in 204 patients, subtotal tumor resection in 54 and partial resection in 30. The shortest operation time was only 30 minutes and the average operation time in patients without intraoperative CSF leakage was 70 minutes. CSF leakage appeared in 3 patients and delayed hemorrhage of Schneiderian membrane in 3 too, but the symptoms were controled after treatment. Conclusion Modification of the surgical instruments and correct application, together with good operative coordination can improve the efficiency of endoscopic pituitary tumor resection through the endonasal transsphenoidal approach.