经单鼻孔鼻中隔蝶窦入路行垂体腺瘤显微切除术患者的加速康复外科策略  

Fast-track surgery strategy for microscopic resection of pituitary adenomas using a singlenostril transsphenoidal approach

作　　者：吴箭午 张建鹤 张帅 王守森 Wu Jianwu;Zhang Jianhe;Zhang Shuai;Wang Shousen(Department of Neurosurgery,900^th Hospital of People's Liberation Army,Fuzhou 350005,China)

机构地区：[1]解放军第九00医院神经外科,福州350005

出　　处：《中华神经医学杂志》2018年第12期1255-1260,共6页Chinese Journal of Neuromedicine

摘　　要：目的 探讨显微镜下经单鼻孔鼻中隔蝶窦入路行垂体腺瘤切除术患者的加速康复外科(FTS)策略.方法 解放军第九〇〇医院神经外科自2015年6月至2017年12月应用显微外科手术治疗垂体腺瘤患者88例,术中均从右侧鼻孔入路,取鼻中隔切口,不切除鼻中隔和中鼻甲,去除蝶窦前壁和鞍底开窗区的黏膜,蝶窦内不填塞止血材料,术毕留置蝶窦引流管.术后4个月应用改良的中文版鼻腔鼻窦结局测试22条(SNOT-22)量表评估患者生存质量.本研究总结显微镜下经单鼻孔鼻中隔蝶窦入路垂体腺瘤切除术的FTS经验.结果 本组肿瘤全切除58例(65.90%),近全切除11例(12.50%),次全切除17例(19.32%),部分切除2例(2.27%),未出现鼻中隔穿孔、迟发性鼻腔出血及颈内动脉损伤等并发症.随访的56例患者SNOT-22量表评分总分大于10分者8例(14%).大多数条目的评分范围为0~0.3分,总体评分范围为0.02~0.88分,平均为(4.75±6.50)分.患者术后不适主要表现在嗅觉减退、头昏、头面部疼痛或压迫感、疲倦及鼻塞5个条目.56例患者中有嗅觉减退者26例,其中轻度嗅觉减退者10例,中度嗅觉减退者9例,重度嗅觉减退者7例.结论 FTS策略的应用有利于保护垂体腺瘤患者鼻腔的正常组织结构,减少鼻腔并发症,提高术后舒适度.Objective To explore the fast-track surgery (FTS) strategy in microscopic resection of pituitary adenomas using a single-nostril transsphenoidal approach. Methods The clinical data of 88 patients with pituitary adenomas, admitted to and underwent microscopic surgery using a transsphenoidal approach in our hospital from June 2015 to December 2017, were retrospectively analyzed. Only one nostril was used during surgery through a transverse incision in the nasal septum; the middle turbinates and nasal septum were not resected, and only the anterior wall of the sphenoidal sinus was removed; fenestration of the mucosa at the sellar floor was conducted; no hemostatic material was used to fill the sphenoidal sinus cavity, and the sphenoidal sinus drainage tube was retained. Four months after surgery, the modified Chinese version of 22-item Sino-nasal Outcome Test (SNOT-22) was used to evaluate the postoperative nasal complications and quality of life of the patients. The experiences with FTS strategy through microscopic resection of pituitary adenomas using a single-nostril transsphenoidal approach were summarized. Results The complete tumor resection rate was 65.90% (58/88), near total resection rate was 12.50% (11/88), subtotal resection rate was 19.32% (17/88), and partial resection rate was 2.27% (2/88). No such complications, as nasal septum perforation, delayed epistaxis, or internal carotid artery injury, were observed. Of the 88 patients, 32 were lost to follow-up; the 56 patients who reported for follow-up were evaluated in accordance with modified Chinese version of SNOT-22: 8 (14%) had a total scores>10; the mean highest and lowest scores for the various items were 0.02 (purulent nasal discharge) and 0.88 (hyposmia), respectively; most items had scores of 0-0.3. The postoperative discomfort experienced by the patients mainly included hyposmia, dizziness, head and facial pain or pressure, fatigue, and nasal congestion. Among the 56 patients, there were 26 with hyposmia, including 10 with mild hyposmia, 9 with

关 键 词：垂体腺瘤 加速康复外科 舒适度 经单鼻孔鼻中隔蝶窦入路 

分 类 号：R736.4[医药卫生—肿瘤]