经鼻内镜下摘除蝶鞍占位性病变(附7例分析)

Transnasal endoscopic management of the sella lesions (a report of 7 cases)

目的 探讨经鼻内镜下蝶鞍手术方法的适应证、应用价值及应用前景，并探索性提出经鼻－经鼻中隔－经筛－经蝶入路摘除蝶鞍巨大肿块。方法 蝶鞍占位性病变病人共７例：垂体微腺瘤５例、巨大垂体腺瘤１例、鞍区炎性坏死性肉芽肿１例。６例采用经鼻－蝶入路；１例采用经鼻－鼻中隔－筛－蝶入路。结果 术前症状在术后均有不同程度的改善（除１例术前有一眼失明者外），无１例出现严重并发症，６例蝶鞍占位获得全切；１例获得次全切。结论 经鼻内镜下摘除蝶鞍占位性病变具有很好的推广应用前景。内镜下经鼻－鼻中隔－筛－蝶入路为蝶鞍巨大肿块的切除提供了一条较佳的手术途径。

Objective To explore the indication, clinical value and prospect of transnasal endoscopic transphenoidal technique in treating sella lesions; and try to use endoscopic transnasal - transseptal - transethmoidal - transphenoidal approach to remove invasive macroadenoma. Methods This group included 7 patients: 5 microadenomas, 1 inflammatory necrotic glanuloma, and 1 invasive macroadenomas. The endoscopic transnasal-transphenoidal technique was applied for management of 6 patients with sella turcica lesions, and endosapic transnasal-transseptal-transethmoidal- transphenoidal approach was used to remove 1 invasive macroadenomas. Results The 2 - 9 months follow-up by CT Scan or MRI indicated that total removal of the lesions in six patients was achieved, one patient was confirmed having a subtotal resection. Preaperative symptoms disappeared or reduced after operation. No new postoperative endocrinological or neurological deficits occurred. Conclusion The transnasal endoscopic approach provides a valuable method for the management of the sella lesions. The modified surgical technique that facilitates better removal of the macroadenoma with less accessible pre-sella extension demonstrates its feasibility.