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目的总结内镜辅助的眶上锁孔入路显微手术切除鞍区病变的经验、手术方法与技巧。方法对52例鞍区病变均采用内镜辅助的眶上锁孔入路显微手术切除。此52例鞍区病变中,垂体腺瘤22例,颅咽管瘤8例,脑膜瘤7例及前循环不同类型动脉瘤15例。结果37例鞍区肿瘤中,肿瘤全切除31例(83.8%,31/37),次全切除或部分切除6例(16.2%,6/37)。15例动脉瘤均准确完全夹闭瘤颈,预后优良者13例(86.7%13/15)和轻残2例(13.3%,2/15)。全组病人无手术死亡及重残,且术前原有症状在术后均有明显不同程度的好转。结论内镜辅助的眶上锁孔入路显微手术能清楚显露鞍区病变与周围结构,创伤小,避免了重要结构的损伤,术后并发症少,效果好。
Objective To summarize the experience, surgical methods and techniques of endoscopic supraorbital keyhole approach for microsurgical removal of sellar lesions. Methods Fifty-two cases of sellar lesions were treated by endoscopic supraorbital keyhole approach. The 52 cases of sellar lesions, pituitary adenoma in 22 cases, 8 cases of craniopharyngioma, meningioma in 7 cases and 15 cases of anterior circulation of different types of aneurysms. Results Totally 31 (83.8%, 31/37) resections were performed in 37 cases of sellar tumors. Subtotal or partial resection was performed in 6 cases (16.2%, 6/37). Thirteen cases (86.7%, 13/15) and mild residual disability (13.3%, 2/15) had the best prognosis in all 15 aneurysms. All patients without surgical death and severe disability, and preoperative symptoms were significantly improved after surgery in varying degrees. Conclusions Endoscopic assisted supraorbital keyhole approach microsurgery can clearly reveal the lesion and surrounding structures in traumatic region. It is less traumatic and avoids the injury of important structures. The postoperative complications are less and the effect is good.