经口鼻蝶窦径路切除垂体腺瘤

The trans-oral,nasal,and sphenoidal approach to pituitary adenoma.

目的 探讨经口鼻蝶窦径路切除垂体腺瘤的手术方法和疗效。方法 采用经口鼻蝶窦径路切除垂体腺瘤 2 0例 (肿瘤直径 >2 0mm)。手术沿唇下横切口 ,切除筛骨垂直板 ,进入蝶窦。修正牵开器正好指向蝶窦前壁与下壁转折处。据影像学显示 ,进一步确定中线及鞍底开窗位置和大小。用吸引器及不同的刮匙切除肿瘤 ,最后切除鞍上肿瘤。同时对肿瘤切除和手术定位技巧进行观察和总结。结果 所有病例手术定位准确、手术顺利。治愈 11例 (5 5 % )、好转 7例 (35 % )、无效 2例 (10 % )。无局部感染、死亡和其他严重并发症。结论 经口鼻蝶窦径路切除垂体腺瘤安全可靠。

Objective To discuss the techniques and operative results of th e trans-oral,nas al,and sphenoidal approach to pituitary adenomas.Method 20 case s of pituitary a denomas(>20mm)were removed by the trans-oral,nasal,and sphenoidal approach.The surigcal approach made an incision in the upper vestibular fornix from cuspid to cuspid,removed a part of cribriform plate and reached the anterior wall of the sphenoidal sinus.Other steps were as usual.Result All the opera tions were succes sful.11 cases(55%)were cured,7 cases(35%) had improvements,2 cases(10%) were of no effect.No post-operative local infection,death or others serious complicatio n s occured. Conclusion The trans-oral,nasal,and sphenoidal app roach is safe and effective for the resection of pituitary adenomas.