鼻内镜下经蝶窦垂体大腺瘤切除术的临床研究

A clinical reaserch of endoscopic endonasal transsphenoidal surgery for pituitary macroadenoma

目的：探讨鼻内镜下经蝶窦垂体大腺瘤及巨大腺瘤切除的技术方法。方法：回顾性分析27例垂体大腺瘤患者的手术方法、术后并发症及随访结果。结果：所有患者术后均无鼻出血、颅内出血、脑脊液鼻漏、血糖增高并发症出现。术中发现5例患者侵犯海绵窦,2例包绕颈内动脉,7例压迫视交叉,1例侵犯视神经。2例患者术后出现视力下降,其中1例考虑填塞物过紧,抽出填塞物保守治疗后视力恢复至术前水平;另1例术后出现视力丧失（术前视力0.1）,经保守治疗后恢复光感。4例患者术后出现尿崩,经1~7d维持水电解质平衡治疗后得到控制,未发现永久性尿崩症患者。结论：鼻内镜下经蝶窦垂体大腺瘤切除是安全有效的手术方法。

Objective：To share our exprience with the surgical management of pituitary macroadenoma and giant adenoma excision technique through the endoscopic transsphenoidal approach.Method：A retrospective analysis data of 27 patients with pituitary macroadenoma and giant adenoma surgery methods,postoperative complications and follow-up results.Result：All patients have no postoperative complications happened such as：nasal bleeding,intracranial hemorrhage,cerebrospinal fluid leak,blood sugar increased.Tumors invaded cavernous sinus in 5cases,surrounded internal carotid artery in 2cases,compressed optic chiasma in 7cases and encroached optic nerve in 1case.Postoperative vision decline occurred in 2cases：1case recovered to the preoperative level after being taken out nasal stuffing and with conservative treatment,1case（preoperative visual acuity 0.1）restored light perception after conservative treatment.Postoperative diabetes insipidus occurred in 4cases,and recovered in next week with corresponding therapy.Conclusion：Endoscopic endonasal transsphenoidal surgery is a safe and effective surgical technique.