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目的全内镜经鼻蝶入路治疗鞍区病变具有创伤小、切除率高的特点,是目前研究的热点。本研究拟通过总结全内镜技术经单鼻孔-蝶窦入路手术治疗鞍区病变的经验,探讨该技术在治疗鞍区病变中的优势和不足。方法回顾性分析2010-03-28-2015-11-12北京大学人民医院神经外科收治的35例采用全内镜经单鼻孔-蝶窦入路手术治疗的鞍区病变患者的临床资料、手术视频及随访结果,并对肿瘤切除程度、症状缓解率和并发症的发生率进行了评估。结果 35例患者中垂体腺瘤30例(85.71%),包括无功能性垂体腺瘤20例,泌乳素腺瘤6例,生长激素腺瘤4例。拉克氏囊肿3例,蝶窦脓肿1例,骨软骨瘤1例。最常见的症状为视力视野障碍21例,其次为头痛头晕9例,闭经泌乳6例,肢端肥大4例,动眼神经麻痹1例。肿瘤全切率85.71%(30/35),近全切3例,大部切除2例。最常发生的并发症为脑脊液漏5例,本组无死亡病例。门诊随访6个月~6年,所有患者临床症状改善,核磁共振未见肿瘤复发或再生长。9例(9/10)功能性垂体腺瘤患者激素水平恢复正常。结论全内镜技术可提供良好的手术视野,有助于提高鞍区肿瘤的切除率和对周围重要结构的保护,从而减少并发症的发生。
The purpose of endoscopic transnasal approach for the treatment of sellar lesions trauma with a small, high removal rate is the focus of current research. This study intends to summarize the experience of endoscopic sinus surgery through the single nostril - sphenoid sinus surgery in the treatment of sellar lesions, to explore the advantages and disadvantages of this technology in the treatment of sellar lesions. Methods retrospectively analyzed 2010-03-28-2015-11-12 Peking University People’s Hospital, Department of Neurosurgery, 35 cases of total endoscopic single nostril - sphenoid sinus surgery in the treatment of patients with saddle area clinical data, surgical video And follow-up results, and the degree of tumor resection, symptom relief rate and the incidence of complications were evaluated. Results Thirty cases (85.71%) of pituitary adenomas were found in 35 cases, including 20 cases of non-functional pituitary adenoma, 6 cases of prolactinoma and 4 cases of growth hormone adenoma. 3 cases of Raksberg’s cyst, 1 case of sphenoid abscess and 1 case of osteochondroma. The most common symptoms were visual field disorders in 21 cases, followed by headache and dizziness in 9 cases, 6 cases of amenorrhea, acromegaly in 4 cases, oculomotor nerve paralysis in 1 case. Total tumor resection rate was 85.71% (30/35), nearly complete resection in 3 cases and partial resection in 2 cases. The most common complication of cerebrospinal fluid leakage in 5 cases, no deaths in this group. Outpatients were followed up for 6 months to 6 years, all patients with clinical symptoms improved, no tumor recurrence or re-growth by nuclear magnetic resonance. Hormone levels returned to normal in 9 patients (9/10) with functional pituitary adenoma. Conclusion Endoscopic technique can provide a good field of vision, which can help improve the resection rate of the tumor in the sellar region and protect the surrounding important structures, thereby reducing the incidence of complications.