鼻内镜下经鼻蝶垂体瘤切除术

Transnasal-transsphenoidal endoscopic surgery in hypophysectomy

目的探讨由鼻科和神经外科医师共同实施鼻内镜下经蝶窦行垂体瘤切除术的方法与效果。方法手术小组在鼻内镜下对36例垂体瘤患者实施了手术治疗。先由鼻科医师行鼻腔及蝶窦手术，扩大蝶窦自然口进入蝶窦。切除鞍底前下部的骨质，暴露垂体硬膜。后由神经外科医师切开垂体硬膜，切除肿瘤。检查无肿瘤残留、无出血后，由鼻科医师修复鞍底、填塞蝶窦和鼻腔。结果本组患者症状在术后均获改善或恢复正常，21例视力下降者中，13例恢复正常，8例好转。内分泌功能障碍者的症状体征均有不同程度的好转或消失。8例头痛症状均消失。3-6个月后复查NRI显示：29例全部切除，7例大部切除。本组患者无一例出现严重并发症。5例有一过性脑脊液鼻漏。3例尿多，3-6日后恢复正常。结论鼻内镜下经蝶垂体瘤切除术是一种创伤小、疗效好、安全性高的手术方法。由鼻科和神经外科医师组成的手术小组实施手术，疗效更佳。

Objective To evaluate the method and curative effect of transnasal and transsphenoidal endoscopic approach technique in hypophysectomy by rhinologist and neurosurgeon. Methods A group of 36 cases of pituitary tumor undergone trasnasal-transsphenoidal endoscopic surgery in between Oct. 2004 and Oct. 2009 was observed. The approach was began through the nasal cavity on the side of the major part of tumor or well-developed sphenoid sinus by a rhinologist. The 1/3 part of the posterior middle turbinate was removed and mucosa reserved for postoperative filling. The ostium of sphenoid sinus was found and enlarged enough on the anterior wall of the sphenoid sinus, the floor of sella turcica was fractured and enlarged adequately so the durra of pituitary was exposed. Next, the dura was incised cruciformly and the adenoma was resected with curette or tumor clamp by the neurosurgeon. Finally, the breach of the floor of sella turcica was repaired, and the cavity of nose and sphenoid sinus was packing with stuffing by the rhinologist. Results The post operation symptom improved or recovered. In 21 Cases of impaired vision, 13 of them recovered,and 8 improved. The high level of hormones also improved in different degrees. Headache symptom is totally gone in 8 cases. Among the 36 cases, there were 29 cases of entire resection of the tumor （80.6%）, 7 cases of subtotal resection. No serious complication or death cases were found except 5 cases of temporary cerebrospinal rhinorrhea and 3 cases of diabetes insipidus which recovered in 3 to 6 days after operation. Conclusion The transnasal-sphenoidal endoscopic technique in hypophysectomy operated by rhinologist and neurosurgeon carries out distinct advantages, such as be simple, safe and minitraumatic.