局麻下经鼻内窥镜垂体瘤切除术11例

A Study on Nasal Endoscopic Pituitary Tumor Surgery under Local Anesthesia

目的探讨局麻下经鼻内窥镜垂体瘤切除的可行性。方法 11例患者术前行1%地卡因喷雾麻醉,术中1%利多卡因行筛前、筛后神经及碟腭神经浸润麻醉,其中两例术中给予强化局麻,经鼻内窥镜开放蝶窦,充分暴露鞍底,磨除鞍底,切开硬脑膜,将垂体瘤完整或部分切除,同时术中使用简易吸引止血装置。结果 11例患者均顺利完成手术,术中9例患者未诉任何不适,两例诉有疼痛、恶心,术后6例伴视力下降、视野缺损的患者术后复查有不同程度恢复,2例术后出现尿崩,保守治疗一周好转。术后3月复查MRI提示3例完整切除,5例大部分切除,3例部分切除。结论局麻下可以顺利完成经鼻内窥镜垂体瘤切除,自制简易吸引止血装置可以部分弥补单手操作的不足。

Objective To probe into the feasibility and treatment of endoscopic pituitary tumor surgery under local anesthesia.Methods 11 patients were applied 1% anesthesia with dicaine before the operation,and subsequently 1% anesthesia infiltration with Lidocaine were performed on ethmoidal nerve,screen nerve and palatine nerve disc in the process of operation.And in 2 cases strengthening local anesthesia and self-made hemostasis device were applied to the patients.Results The operation ran smoothly on the 11 patients only with 2 cases of pain and vomiting.The 6 cases with hypopsia and visual field defect after operation showed improvement in the check-up.The 2 cases with Diabetes insipidus recovered after 1 week treatment.The MRI re-examination 3 months after the operation indicated 3 cases of total resection,5 cases of subtotal resection and 3 cases of partial resection.Conclusion It is feasible to carry out Endoscopic pituitary tumor surgery under local anesthesia and self-made hemostasis device could make up the deficiency of one-hand operation.