经单鼻孔蝶窦入路切除垂体腺瘤的并发症及防治  

Complications of Microsurgery via Single-side Nostril-sphenoidal Approach for Pituitary Adenoma and Their Countermeasures

作　　者：周开宇[1] 王广涛[1] 罗永康[1] 金杭煌[1] 蔡志毅[1] 

机构地区：[1]台州学院医学院附属台州市立医院神经外科,台州318000

出　　处：《中国微创外科杂志》2010年第3期269-272,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：浙江省医药卫生科技计划A类资助项目(编号:2009A226);浙江省台州市科技局资助项目(编号:051KY48);浙江省台州学院资助项目(编号:08ND33);浙江省台州市椒江区科技局资助项目(编号:31067)

摘　　要：目的探讨经单鼻孔蝶窦入路显微手术切除垂体腺瘤并发症的防治。方法回顾分析2003年9月～2008年8月经单鼻孔蝶窦入路手术治疗垂体腺瘤12例术中、术后出现并发症的临床资料。结果术后发生尿崩症11例,8例在术后1个月内恢复正常,2例在术后半年内恢复正常,1例术后2年存在轻度尿崩症;电解质紊乱9例,出院时均纠正;脑脊液鼻漏1例,内镜下经蝶手术修补后治愈;脑膜炎2例,经内科对症处理治愈;垂体功能低下1例,激素替代治疗后好转;鼻中隔穿孔2例,未经特殊处理;鞍内形成小血肿1例,2周后CT复查血肿自行吸收消失。12例随访4～60个月,(32±7)月,1例术后2年仍存在轻度尿崩症,1例术后3年存在垂体功能低下,其余10例均正常。结论扎实的解剖知识、娴熟的显微操作、严密的术后观察、积极防治并发症是治疗成功的重要条件。Objective To explore the complications of pituitary adenoma resection through the single-side nostril-sphenoidal approach,as well as the countermeasures for the complications.Methods Between September 2003 and August 2008,we performed pituitary adenoma resection on 12 patients by microsurgery via the single-side nostril-sphenoidal approach.The intraoperative and postoperative complications were recorded.Results After the operation,eleven cases developed diabetes insipidus,eight of them recovered in one month,two recovered in half a year,and the other one still had symptoms of diabetes insipidus two years after the surgery.Nine patients had electrolyte disorders,all of them were cured before being discharged.One case showed cerebrospinal fluid rhinorrhea,had thus received endoscopic repair.Two patients developed meningitis and then were cured by medicines.Pituitary insufficiency was observed in one case,on whom hormone replacement therapy achieved a good outcome.Two patients was found septal perforation but received no treatment.Intrasellar hemorrhage was detected in 1 case,the hematoma was then revealed to be absorbed in two weeks on CT scan.Twelve of the patients received follow-up for a mean of（32±7）months（ranged from 4 to 60 months）.During the period,diabetes insipidus was not cured in one patient in two years,and pituitary insufficiency still existed in one patient in three years;the other 10 cases showed normal examination results.Conclusions Good outcomes of pituitary adenoma resection via the single-side nostril-sphenoidal approach rely on good anatomy knowledge,skilled micromanipulation,rigorous postoperative observation,and positive prevention and treatment of the complications.

关 键 词：垂体腺瘤 经蝶手术 并发症 

分 类 号：R736.4[医药卫生—肿瘤]