基层医院鞍区病变微侵袭外科治疗探讨  

Microinvasional surgery for the occupying lesions at sella region in the matrical hospital

作　　者：夏家林[1] 王永胜[1] 李书清[1] 

机构地区：[1]山东省滨州市中心医院,251700

出　　处：《中国实用医刊》2010年第23期7-10,共4页Chinese Journal of Practical Medicine

摘　　要：目的 探讨基层医院在蝶鞍区病变微侵袭外科治疗的可行性及最佳手术方式.方法 回顾性分析2003年7月至2009年5月收治的70例蝶鞍区病变患者的临床资料.其中垂体腺瘤56例,垂体转移癌1例,颅咽管瘤3例,鞍结节脑膜瘤2例,脊素瘤1例,空蝶鞍综合征3例,脑脊液鼻漏2例,视神经损伤2例.显微镜下经鼻一蝶入路,采取两种入路方式,手术29例,显微镜、鼻内窥镜联合应用经鼻、蝶入路手术15例,鼻内窥镜下采取两种入路方式手术26例.结果 56例垂体腺瘤全切27例,次全切24例,部分切除5例,垂体转移癌予以大部分切除,鞍结节脑膜瘤2例全切,脊索瘤1例次全切,颅咽管瘤3例部分切除,空蝶鞍综合征填塞术3例,2例术后视力改善明显,1例改善不明显,脑脊液漏2例均成功修补,视神经管减压1例效果良好,1例无效.结论 基层医院科室联合,技术、设备共享,可以在蝶鞍区病变微侵袭外科治疗方面取得突破;内镜下经鼻、蝶入路是处理鞍区病变的最佳手术方式,但不能取代显微外科手术,最大限度的利用各自的优点,在鞍区病变的治疗方面将发挥更大作用.Objective To explore the feasibility and optimal operating methods of microinvasional surgery for the occupying lesions at sella region in matrical hospital. Methods to analyse 70 cases with lesion at sella region from 2003 to 2009, including 56 patients with pituitary adenoma, 1 with metastatic carcinoma, 3 with craniopharyngioma, 2 with meningioma, 1 with chordoblastoma, 3 with empty sella syndrome, 2 with cerebrospinal rhinorrhea, 2 with optic nerve decompression. Twenty-nine patients were managed by micro transnasal-sphenoidal approach, 15 by combined application of nasal endoscope and microscope, 26 by nasal endoscope. Results Of all 56 patients with pituitary adenoma, the tumors were totally removed in 27 cases and subtotally removed in 24 cases, partial removed in 5 cases. The tumor of the patient with metastatic carcinoma was subtotally removed, totally removed in 2 cases with meningioma, subtotally removed in 1 case with chordoblastoma. Of all 3 patients with empty sella syndrome, eyesight was evidently improved in 2 cases, no changed in one. Neoplasty was done well in 2 cases with cerebrospinal rhinorrhea. Optic nerve decompression has a good effect in one, ineffective in one cases. Conclusions Microinvasional surgical therapy can get breakthrough through the alliance of clinical divisions and the share of facilities in matrical hospital. The optimal operating method is the transnasal-sphenoidal approach by nasal endoscope, but it can not replace microsurgical intervention. We should utilize respective advantages in the treatment for the occupying lesions at sella region.

关 键 词：基层医院 鞍区病变 微侵袭治疗 

分 类 号：R651[医药卫生—外科学]