垂体腺瘤经鼻蝶入路手术鼻中隔根部黏骨膜切口的改良  

Modified nasal septum root mucoperiosteum incision of pituitary adenomas via endonasaltranssphenoidal approach

作　　者：程友[1] 王天友[1] 薛飞[1] 季俊峰[1] 许莉[1] 周玫[1] 杭春华[2] 

机构地区：[1]南京军区南京总医院耳鼻咽喉头颈外科,南京210002 [2]南京军区南京总医院神经外科,南京210002

出　　处：《中华神经医学杂志》2016年第2期199-202,共4页Chinese Journal of Neuromedicine

基　　金：全军“十二五”面上课题(CNJ13C005) General Project of PLA during Twelfth Five-year Plan Period

摘　　要：目的探讨垂体腺瘤经鼻蝶入路手术鼻中隔根部黏骨膜切口的改良方法，以减少术后与切口相关的动脉性鼻出血、鼻中隔穿孔及嗅觉障碍等鼻腔整体并发症的风险。方法南京军区南京总医院耳鼻咽喉一头颈外科自2013年1月至2013年6月对16例采用经鼻蝶入路垂体腺瘤切除的患者在术中行改良的鼻中隔根部黏骨膜切口，并观察其术后鼻腔并发症发生情况。结果16例垂体腺瘤全切除加次全切除率达93．8％．术后均未发生动脉性鼻出血及鼻中隔穿孔。术前和术后3个月的嗅觉测试分析显示，15例术前嗅觉功能正常患者术后嗅觉功能无明显减退，1例术前嗅觉功能障碍患者术后嗅觉功能障碍未发生进一步的恶化。结论采用改良的鼻中隔根部黏骨膜切口．可以维护蝶腭动脉蒂部及手术对侧鼻中隔黏膜的完整性，充分保护鼻中隔嗅带，减少术后与切口相关的动脉性鼻出血、鼻中隔穿孔及嗅觉障碍等并发症的风险。Objective To explore the modified nasal septum root mucoperiosteum incision of pituitary adenomas via endonasal transsphenoidal approach, and reduce the incision-related postoperative complications as rhinorrhagia, septurnperforation and dysosmia. Methods Sixteen patients with pituitary adenomas, admitted to and underwent modified nasal septum root mucoperiosteum incision of pituitary adenomas via endonasal transsphenoidal approach in our hospital from January 2013 and June 2013, were chosen in our study. The postoperative nasal complications were observed. The clinical data of them were analyzed retrospectively. Results Of all the 16 patients, total or subtotal removal rate was 93.8%. Rhinorrhagia or septumperforation did not appear. Dysosmia was not appeared in 15 patients with normal olfactory function; one patient had preoperative olfactory dysfunction, without getting worsen three months after surgery. Conclusion The reformative nasoseptal root mucoperiosteum incision of transsphenoidal surgery for pituitary adenomas can maintain the integrality of sphenopalatine artery and nasoseptal olfactory mucosa, and decrease the incidence of postoperative nasal complications, such as rhinorrhagia, septumperforation and dysosmia.

关 键 词：垂体腺瘤 经鼻蝶入路 黏骨膜切口 动脉性鼻出血 鼻中隔穿孔 嗅觉障碍 

分 类 号：R736.4[医药卫生—肿瘤]