经单鼻孔蝶窦入路切除垂体腺瘤

Single-nostril approach for pituitary adenoma

目的 介绍经单鼻孔蝶窦入路切除垂体腺瘤的显微手术技术以及并发症的处理。方法 所有病人均经单鼻孔蝶窦入路切除肿瘤。先扩张术侧鼻孔，将扩鼻器直接插入鼻孔深处直抵蝶窦前壁，扩张后鼻中隔被完整地推向对侧。在手术显微镜下，分离蝶窦前壁的粘膜，然后凿除蝶窦前壁骨质，进入蝶窦。术后31．5％接受放疗。结果 本组未发生严重永久性并发症，无死亡。412例（72．7％得到随访，随访时间3个月～8年，平均3年6个月。72．1％治愈，20．1％控制，7．8％复发。 结论 该入路损伤小，安全，并发症少，省时， 简便易行，适用于切除绝大多数垂体腺瘤。

Objective To introduce the microsurgical operative technique for treating pituitary adenoma via a single-nostril approach to sphenoidal sinus and postoperative complication． Method All patients were operated via a single-nostril approach to sphenoidal sinus． The operative techniques were without incision the speculum straightly upon to the anterior wall of the sphenoidal sinus． As expanding the speculum the middle septum was perfectly pressed to the opposite side． Under the operative microscope the anterior wall mucosa of the sphenoidal sinus was dissected away the anterior wall bony of the sphenoidal sinus was chipped off and then the sinus approached． Other steps were as usual． postoperative Irradiation was in 31．5％． Result None of the patients were suffered from permanent severe complications and the operative mortality was zero． 412 cases（72．7％ were fowlled-up from 3 monthers to 8 years average 3．5 years cure rate was in 72．1％， control in 20．14％ recurrence in 7．8％． Conclusion These data indicates that this approach is less destructive less complications safety save time easy to perform and very useful to the majority of pituitary adenoma resection．