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目的:探讨应用神经内镜技术和神经导航技术在单鼻孔手术切除蝶窦发育不良型垂体腺瘤的意义与价值。方法:在神经导航引导内镜下经单鼻孔微创手术治疗垂体瘤22例,其中泌乳素腺瘤15例,生长激素腺瘤2例,无功能腺瘤5例。结果:神经内镜和神经导航下全切肿瘤146例,近全切4例,大部分切除12例,术后13例内分泌化验恢复正常,其中18例术前有视力损害者,术后15例较术前好转,3例无变化;1例病人出现一过性脑脊液漏。22例病人随访3个月～11个月,未发现复发。无鼻中隔穿孔、萎缩性鼻炎等并发症。结论:神经导航引内镜下经单鼻孔手术切除蝶窦发育不良型垂体腺瘤具有深部照明好,鼻腔结构损伤小、操作简捷、术后恢复快等优点,神经导航技术的应用可以避免蝶窦多房分隔的干扰,快速确定鞍底位置、判定肿瘤切除的程度与范围、减少手术对肿瘤周围神经血管结构的副损伤,二者结合能提高手术全切率,减少复发,是蝶窦发育不良型垂体腺瘤微创外科治疗的理想手段。
Objective: To explore the significance and value of endoscopic sinus surgery and neuronavigation in resection of sphenoid dysplastic pituitary adenoma by single nostril surgery. Methods: Twenty-two cases of pituitary adenomas were treated with single-nostril minimally invasive surgery guided by nerve guidance. Among them, 15 were prolactinomas, 2 were growth hormone adenomas and 5 were non-functioning adenomas. Results: The total excision of tumor under neuroendoscopy and neuro-navigation was performed in 146 cases, nearly 4 cases were resected completely, 12 cases were resected in most cases, and 13 cases had endocrine tests returned to normal after surgery. Eighteen cases had visual impairment before operation and 15 cases Better than preoperative, 3 cases no change; 1 case of transient cerebrospinal fluid leakage. 22 patients were followed up for 3 months to 11 months, no recurrence was found. No nasal septum perforation, atrophic rhinitis and other complications. Conclusions: Nerve navigation guided endoscopic nostril surgery to remove sphenoidal dysplasia pituitary adenoma with deep illumination, nasal structure injury is small, simple operation, postoperative recovery advantages, the application of neural navigation technology to avoid sphenoid sinus Multiple room separation interference, rapid determination of the position of the saddle to determine the extent and extent of resection of the tumor to reduce the surgical damage to the peripheral blood vessels of the tumor side of the injury, the combination of the two can improve the rate of surgical resection and reduce recurrence is sphenoidal dysplasia Pituitary adenomas minimally invasive surgical treatment of the ideal means.