内窥镜辅助的颅底手术  

Surgery of the skull base assisted by sinus endoscope

作　　者：汪银凤[1] 叶非常[1] 王明善[1] 刘认华[1] 金自仓[1] 胡燕明[1] 孙敬武[1] 李显光[1] 

机构地区：[1]合肥安徽省立医院耳鼻咽喉科,230001

出　　处：《中华耳鼻咽喉科杂志》2001年第3期196-198,I005,共4页Chinese Journal of Otorhinolaryngology

摘　　要：目的　探讨鼻内窥镜在颅底手术中应用的可行性和临床意义。方法　对鼻内窥镜下颅底区域手术 44例进行回顾性分析 ,其中鼻内进路颅底手术 2 5例 ,传统进路的颅底手术 19例。结果44例颅底手术中 ,1例紧嵌于斜坡内金属异物未能取出 ;1例垂体瘤患者鞍底开窗后穿刺均为血性 ,仅做鞍底扩大开窗和穿刺活组织检查 ,术后视力有所改善 ;1例复发性颅咽管瘤并发梗阻性脑积水 ,术后颅高压未完全改善 ;1例蝶窦腺癌侵犯鞍底及鞍旁 ,仅行部分切除术加激光治疗 ,随访 2年半无复发 ,其余病例均一次手术治愈。并发症 :脑脊液鼻漏 2例 ,尿崩症 1例 ,均经保守治疗短期内治愈 ,鼻中隔穿孔 1例 ,未做特殊处理。结论　①经鼻内窥镜颅底区域的手术是可行的 ,只要病例选择适当 ,可充分体现该手术进路直接、创伤小、无颜面切口等优点 ;②和手术显微镜结合使用 ,可弥补手术显微镜只能观察物镜直线正前方结构 ,不能窥视弯曲的通道或较深隐窝的局限性 。Objective To explore the feasibility and clinical value of the endoscopic operations around the skull base. Methods A retrospective study was made of 44 cases treated by endoscopic operations. Twenty five cases underwent intranasal endoscopic operations. Results Forty of 44 cases were cured by one stage surgery. One case of cartridge foreign body clamped in clivus was not successfully removed; only window operation and puncture biopsy were done in another case of pituitary adenoma; high cranial pressure has not been completely reduced after operation in the third case with relapsing craniopharyngioma a companied with obstructive hydrocephalus. One case of sphenoidal malignant adenoma involving saddle base and extended laterally was partly resected. Complications were follows: cerebrospinal fluid rhinorrhea in 2 cases, diabetes insipidus in 1 case, all of them were cured by conservative treatment; nasal septum perforation in 1 case, without any treatment. Conclusions The endoscopic skull base surgery by intranasal approach is feasibility. Intranasal approach has direct path, slight wound and no wound in face. Combined with operation microscope, sinus endoscope can make up for its limits.

关 键 词：内窥镜 颅底 SURGICAL procedures OPERATIVE 外科手术 鼻眼 

分 类 号：R762[医药卫生—耳鼻咽喉科]