单鼻孔经蝶窦入路切除垂体腺瘤10年的手术体会

摘要

目的：探讨经单鼻孔蝶窦入路手术治疗垂体腺瘤的方法和经验。方法回顾性分析2004年5月至2014年5月10年期间，采用经单鼻孔蝶窦入路手术的476例垂体腺瘤患者的临床资料、手术方法、手术后并发症，其中应用神经内镜辅助治疗21例。结果手术全切除357例（75％），大部分切除102例（21．4％），部分切除17例（3．6％）。全部病例均进行随访：视力改善62例（87．3％）；内分泌功能有不同程度改善283例（78．8％）；手术并发症：一过性尿崩51例，发生脑脊液鼻漏81例，昏迷2例。结论单鼻孔蝶窦入路外科手术最大限度地利用了鼻腔的自然间隙，具有入路直接、创伤轻微、手术时间短、并发症少等优点，术后康复快，垂体功能保存率高等优点，是微创治疗垂体腺瘤的一种安全有效的方法。同时，应用神经内镜可以提高手术效果。%Objective To describe the experience of single-nostril transsphenoidal approach for treatment of pituitary adenoma.Methods From May 2004 to May 2014,the clinical data,surgical methods and postoperative complications of 476 cases with pituitary adenoma were analyzed restro-spectively.21 cases of them were treated by endoscopic endonasal transsphenoidal surgery.Results Total resection were achieved in 357 patients(75%),subtotal in 102 patients(21.4%),and partial in 17 patients(3.6%) .Follow-up were performed for 2-24 months in all patients.62 patients had vision improved in 71 patients with vision decreasing before operation.The blood endocrine status of 283 patients achieved an improvement after the operation in 359 patients ( 78.8%) .51 cases suffered transient diabetes insipidus.81 cases suffered from cerebrospinal fluid leak and 2 patients suffered postoperative coma.Conclusions The single-nostril transsphenoidal approach for pituitary tumors is of advantages as minimal invasiveness,simple operation,efficient procedure,safety mild response and shorter hospital stay.It will be improved with the neuroendoscopic surgery applied widely.