单鼻孔-蝶窦入路切除垂体腺瘤手术的并发症及防治方法  

Complications and prevention of single-nostril transsphenoidal surgery for pituitary adenomas

作　　者：计颖[1] 牛朝诗[1] 丁宛海[1] 凌士营[1] 鲍得俊[1] 姜晓峰[1] 傅先明[1] 汪业汉[1] 

机构地区：[1]安徽医科大学附属安徽省立医院神经外科,合肥230001

出　　处：《中华神经医学杂志》2008年第4期384-387,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨经单鼻孔-蝶窦入路切除垂体腺瘤的常见并发症及其防治措施。方法收集241例经单鼻孔-蝶窦入路切除垂体腺瘤的临床资料和1～36个月的随访结果。统计患者性别、年龄、肿瘤大小、质地、术后并发症及随访结果等资料。结果肿瘤全切除171例（71％），次全切除28例（11．6％），大部分切除26例（10．7％），部分切除16例（6．6％）。术后发生暂时性尿崩症38例（15．8％），视力下降12例（4．9％），脑脊液鼻漏4例（1．6％），单侧动眼神经损伤2例（0．8％），术中发生严重海绵间窦出血2例（0．8％）。随访鼻中隔穿孔2例（0．8％）；垂体功能下降2例（0．8％），1例治疗后好转；无颈内动脉损伤出血，无死亡病例。结论经单鼻孔-蝶窦入路切除垂体腺瘤尽管创伤很小，但是仍有一定比例的并发症发生，为了更好地预防并发症的发生，减少死亡，要熟悉每个患者的手术局部解剖，提高手术技巧，不断总结临床经验。Objective To discuss the common complications of single-nostril transsphenoidal surgery for pituitary adenomas, and the prevention ofpostsurgical complications. Methods Clinical and follow-up （1-36 months） data of 241 patients with pituitary adenomas treated with single-nostril transsphenoidal surgery were collected and analyzed retrospectively by EXCEL software with regard to the patients＇ sex, age, tumor dimension and quality, postsurgical complications, and so on. Results Total removal of tumors was achieved in 171 （71%） cases, subtotal removal in 28 （11.6%）, most removal in 26 （10.7%）, and partial removal in 16 （6.6%）. After the operation, 38 （15.8%） cases were found with transient diabetes insipidus, 12 （4.9%） cases with worse sight, 4 （1.6%） with cerebrospinal fluid rhinorrhea, 2 （0.8%） with unilateral oculomotor paralysis, and 2 （0.8%） with anterior pituitary insufficiency; during the operation, there were 2 （0.8%） cases with severe cavernous sinus hemorrhage, 2 （0.8%） with nasoseptal perforation, no internal carotid artery injuries or death. Conclusions Though the damage of single-nostril transsphenoidal surgery for pituitary adenomas was small, there were a few complications. In order to prevent the complications and reduce the mortality, we should be familiar with the regional anatomy and better master the surgical skills, meanwhile, clinical experience is also very important in improving the therapeutic efficacy.

关 键 词：垂体腺瘤 经单鼻孔-蝶窦入路 并发症 预防 

分 类 号：R736.4[医药卫生—肿瘤]