论文部分内容阅读
目的 ;总结神经内镜下经鼻-蝶窦入路行垂体腺瘤切除的手术技巧。方法 2008年4月~2011年3月间共60例内镜下经单鼻孔蝶窦入路切除垂体腺瘤。结果肿瘤全切除32例,近全切除17例,大部切除9例,活检2例;术中脑脊液漏9例,予修补;海绵窦出血3例,无颈内动脉损伤;术后一过性尿崩症11例,脑脊液漏2例,脑膜炎1例,均治愈。术后病理示:非功能性腺瘤26例,生长激素腺瘤16例,泌乳素腺瘤12例,促肾上腺皮质激素腺瘤6例。随访1个月~3年,所有患者临床症状改善;肿瘤复发8例,予放射治疗5例,再次手术3例。结论神经内镜为经鼻-蝶手术提供了独特的解剖细节,内镜下经鼻蝶窦垂体瘤切除术安全可靠;术者对内镜下解剖的熟悉,手术器械的熟练使用及操作技巧,与肿瘤切除程度及降低手术并发症密切相关。
Objective To summarize the surgical techniques of endoscopic pituitary adenoma excision under endoscopic sinus surgery. Methods From April 2008 to March 2011, a total of 60 cases underwent endoscopic resection of pituitary adenomas by single nostril sphenoid sinus approach. Results Tumor resection in 32 cases, nearly total resection in 17 cases, 9 cases of partial resection, biopsy in 2 cases; intraoperative cerebrospinal fluid leakage in 9 cases, to repair; cavernous sinus hemorrhage in 3 cases, no internal carotid artery injury; transient postoperative transient 11 cases of diabetes insipidus, 2 cases of cerebrospinal fluid leakage, 1 case of meningitis were cured. Postoperative pathology showed: 26 cases of non-functional adenoma, 16 cases of growth hormone adenoma, prolactinoma in 12 cases, adrenocorticotrophic adenoma in 6 cases. Followed up for 1 month to 3 years, all patients improved clinical symptoms; tumor recurrence in 8 cases, radiotherapy in 5 cases, reoperation in 3 cases. Conclusions Endoscopic treatment of nasal-butterfly provides unique anatomical details. Endoscopic transnasal sinus pituitary adenoma resection is safe and reliable. The surgeon is familiar with endoscopic anatomy, skilled use of surgical instruments and operating skills, And tumor resection degree and reduce the surgical complications are closely related.