鼻内镜下鼻腔蝶窦径路垂体腺瘤切除术  

Endoscopic Transnasal Transsphenoidal Surgery for Pituitary Adenoma

作　　者：陈峰[1] 倪红斌[1] 刘志坚[1] 俞晨杰[1] 梁维邦[2] 高下[1] 

机构地区：[1]南京大学医学院附属鼓楼医院耳鼻咽喉-头颈外科,南京210008 [2]南京大学医学院附属鼓楼医院神经外科,南京210008

出　　处：《中国微创外科杂志》2010年第8期691-693,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨鼻内镜下经鼻腔蝶窦径路切除垂体腺瘤的疗效。方法 2002年9月～2008年9月,22例垂体腺瘤在鼻内镜下经扩大的嗅裂暴露蝶窦前壁,打开并扩大蝶窦开口,再行鞍底开窗,切开硬脑膜暴露肿瘤后用刮匙及取瘤钳逐块切除肿瘤。结果完全切除肿瘤19例(86.4%),次全切除(>90%切除)3例(13.6%)。术中2例出现轻度脑脊液鼻漏,同期修补术后恢复良好;术后2例出现尿崩,经保守治疗1周内痊愈。22例术后随访6～60个月,平均21.6月,术后头痛、闭经泌乳和视力障碍等临床症状均有不同程度缓解,复发1例,复发率4.5%(1/22),再次手术后未再复发。结论鼻内镜下经鼻腔蝶窦径路具有良好的术野,该方法切除垂体腺瘤安全有效。Objective To evaluate the efficacy of endoscopic transnasal transsphenoidal surgery for the treatment of pituitary adenoma and the prevention of surgical complications.Methods From September 2002 to September 2008,22 patients with pituitary adenoma were treated by endoscopic transnasal transsphenoidal surgery in our hospital.The anterior wall and ostium of the sphenoid sinus were exposed during the operation so that to enlarge the floor of the sella turcica,and then the dura was incised,and the adenoma was exposed and resected.Results Nineteen cases（86.4%）had total resection and three cases（13.6%）received subtotal resection（ 90%）.Two cases were identified with intraoperative cerebrospinal leakage,which were then repaired immediately.Two cases showed transient diabetes insipidus after the operation,the symptom disappeared in 7 days with conservative treatments.All of the 22 patients were followed up for 6-60 months with a mean of 21.6 months.During the period,the symptoms of headache,visual disturbance,amenorrhea,and galactorrhea were cured or improved;one patient（4.5%）had recurrence in 3 months after the operation and then was cured by re-operation without recurrence.Conclusions Endoscopic transnasal transsphenoidal surgery provides a straight approach to the sellar region,where it offers a multi-angled and close-up view of all the relevant neurovascular structures.The technique is a safe,valuable and effective procedure for removing pituitary adenomas.

关 键 词：垂体腺瘤 鼻内镜 蝶窦径路 

分 类 号：R736.4[医药卫生—肿瘤]