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目的 总结鼻窦镜辅助下经单鼻孔入路垂体瘤显微手术切除术的经验及初步体会。方法鼻窦镜辅助下 ,经单侧鼻腔 ,严格中线入路打开蝶窦前壁 ,暴露鞍底。然后在神经显微镜下行垂体瘤切除 ,最后鼻窦镜下鞍底重建。结果 2 1例患者中 16例一次手术全切除 ,3例次全切除 ,1例巨大生长激素 (growthhormone ,GH)腺瘤大部分切除 ,后经改良翼点入路二次手术切除 ,1例巨大催乳素(prolactin ,PRL)腺瘤分 2次经蝶肿瘤切除 ,术后患者症状均改善。尿崩 2例 ,分别于术后 7d、15d停止 ;脑脊液漏 1例 ,保守治疗 2周治愈。结论 耳鼻喉科医师解剖熟悉 ,鼻窦镜下显露鞍底准确充分 ,神经外科医师显微镜下可克服内镜单手操作的不便 ,二者结合有利于减少经单鼻孔入路垂体瘤切除的创伤 ,提高安全性 ,是一种有效的方法。
Objective To summarize the experience and preliminary experience of microsurgical resection of the pituitary tumor with single nostril assisted by sinusoscope. Methods With the help of sinusoscope, the anterior wall of the sphenoid sinus was opened by unilateral nasal approach with strict midline approach to expose the sella. Then pituitary tumor resection under the nerve microscope, the last sinus endoscopic reconstruction. Results Of the 21 cases, 16 cases were totally surgically excised and 3 cases were subtotally resected. One case of growth hormone (GH) adenoma was excised and the second case was performed by modified pterional approach. One case was huge Prolactin (prolactin, PRL) adenomas were divided into two transsphenoidal tumors and the symptoms of the patients were improved after operation. Urinary collapse in 2 cases, respectively, after 7d, 15d stop; CSF leakage in 1 case, conservative treatment for 2 weeks to cure. Conclusions otolaryngologists are familiar with the anatomy, sinus endoscopy revealed accurate full, neurosurgeons under the microscope can overcome the inconvenience of endoscopic single-handed operation, the combination of the two is conducive to reducing the single nostril pituitary tumor removal and improvement Security is an effective method.