鼻内镜下经鼻中隔后-蝶窦入路切除累及鞍外的鞍区肿瘤  

Removal of sellar tumors involving beyond the sellar turcica via endoscopic trans-nasal-nasal septum-sphenoid approach

作　　者：谭国林[1] 贺广湘[1] 陈江波[1] 李和清[1] 蒋明[1] 刘国辉[1] 

机构地区：[1]中南大学湘雅三医院耳鼻咽喉头颈外科,湖南长沙410013

出　　处：《中国耳鼻咽喉颅底外科杂志》2011年第5期351-354,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的总结内镜下经鼻蝶扩大手术入路切除侵犯鞍外的鞍区肿瘤的临床经验,并对术后疗效及并发症进行评估。方法选择侵犯鞍外的鞍区肿瘤13例,在鼻内镜下经鼻腔切除鼻中隔后端,进入蝶窦,再磨去鞍底及周围骨质,进入鞍区及鞍外,行肿瘤切除术。结果术后病理检查结果显示,13例患者中垂体腺瘤8例,颅咽管瘤4例,脑膜瘤1例;8例肿瘤完全切除(61.5%),4例部分切除(30.7%),1例死亡。术后发生的主要并发症有尿崩症、脑脊液鼻漏、脑膜炎、下丘脑衰竭等。结论侵犯鞍外的鞍区肿瘤可以经鼻内镜下手术切除,但具有一定风险,需要谨慎选择。Objective To summarize the experience in removal of sellar tumors involving beyond the sellar turcica via endoscopic trans-nasal-nasal septum-sphenoid approach,and to evaluate the surgical effect and complications.Methods 13 cases of sellar tumors involving beyond the sellar turcica were involved.In all csess,a procedure was carried out which including endoscopic resection of the posterior part of the middle turbinate,and nasal septum and the anterior wall of bilateral sphenoid sinuses,abrasion of the bone of base-sella and surroundings in order to remove the tumors.The efficacy and complications were assessed.Results Postoperative pathological examination demonstrated that pituitary adenoma occurred in 8 patients,cranopharyngioma in 4 and meningioma in one.The tumors were completely removed in 8 cases,partially removed in 4.The another one died 6 days after operation.The major postoperative complications included diabetes insipidus in 13 cases,cerebrospinal fluid leak in three,meningitis,and hypothalamic failure in one each.Conclusion Modified endoscopic trans-nasal-sphenoid approach may be a choice for sellar tumors involving beyond the sellar turcica.However,it is necessary to make a choice carefully because of the severe surgical risks.

关 键 词：鞍区肿瘤 鼻内镜 疗效 并发症 

分 类 号：R739.41[医药卫生—肿瘤]