单鼻孔蝶窦直接入路切除垂体腺瘤

Resection of pituitary adenoma via endonasal-transsphenoidal approach

采用非选择性经单鼻孔蝶窦直接入路手术切除 5 6例垂体腺瘤。本组病例术中均未作鞍底重建。术后磁共振显示 ,肿瘤直径 <3cm的 37例患者中全切 32例 ,全切率为 86 .4 % ;肿瘤直径≥ 3cm的 19例患者中 5例全切 ,全切率为 2 6 .3%。术后患者临床症状有不同程度改善 ,随访 3～ 12个月未发现严重并发症。单鼻孔蝶窦直接入路不影响面容 ;鞍底中线可以根据解剖结构准确定位 ;开放鞍底有利于防止术后鞍内积血、囊肿的发生 ,促使鞍上残留肿瘤下塌入鞍内 。

This paper is to summarize the primary experience in excision of pituitary adenoma through direct transsphenoid approach. Fifty six consecutive pituitary adenoma cases undergone direct transnasal pituitary adenama resection were reviewed.No seller floor was reconstructed during operation.Post operation MRI revealed that among 37 cases with tumor smaller than 3 cm,86.4%(32) had total tumor resection.For 19 cases with tumor larger than 3 cm only 26.3%(5) had total resection.Symptoms were relieved in severity in all cases.During 2 9 months follow up period,no severe complication was found.Resection of tumor via direct transnasal approach is simple and time saving,and it avoids cosmetic complications.The middle line can be exactly located according to surrounding structures during operation. Open sella can prevent the accumulation of post operative hematoma and subsequent intrasellar cysts,accelerating the descent of the remaining suprasella tumor into the sella;both of which facilitate the extirpation of the remnant tumor for later resection.