摘要
目的总结经单侧鼻孔-蝶窦入路镜下切除垂体腺瘤的体会。方法对12例垂体腺瘤病人均采用经单侧鼻孔-蝶窦入路行肿瘤切除术。结果10例全切除,1例大部切除,1例部分切除。4例病人术后出现短期尿崩,合并不同程度的水电解质紊乱,经口服双氢克脲噻、及时补液3～4d缓解。2例未完全切除肿瘤者术后行X刀放射治疗。本组无一例出现脑脊液漏。12例获随访,平均10.2(6～18)月,均无肿瘤复发,视力减退者均有不同程度改善,尿崩症者均获痊愈。结论肿瘤质地较硬,向鞍上扩展较大时应慎重选择经蝶窦入路;窥鼻镜准确地置于蝶窦前壁的最佳位置,是减少手术创伤的关键;明胶海绵加上EC耳脑胶修复鞍底可避免出现脑脊液漏;出现尿崩、水电解质失衡时应及时纠正。
Objective To summarize the experience of endoscopic resection of pituitary adenoma via unilateral endonasal transphenoidal approach. Method 12 cases of pituitary adenoma underwent resection via unilateral endonasal transphenoidal approach. Results Tumor removed completely in 10 cases, subtotally in 1 case and partially in 1 case. Four cases experienced short-term diabetes insipidus and water-electrolyte imbalance of varied degrees, and symptom relieved within 3 to 4 days treated with oral intaking of diuretic and fluid replacement. The 2 cases of incomplete tumor resection underwent X radiation therapy. There was no leakage of cerebrospinal fluid and recurrence within 6 ～ 18 months of follow-up. Conclusions The transphenoidal approach should be cautiously selected in case the tumor is hard in texture and supra-saddle extended dissection needed. It is beneficial to reduce the operative invasion that endoscope is placed at the best site on the anterior wall of sphenoid sinus. The cerebrospinal fluid leakage can be prevented by saddle bottom repair with gelatin sponge and EC ear-brain glue. The diabetes insipidus and water-electrolyte imbalance should be treated promptly.
出处
《中国现代手术学杂志》
2005年第4期268-270,共3页
Chinese Journal of Modern Operative Surgery
关键词
垂体肿瘤
腺瘤
经鼻孔-蝶窦入路
pituitary neoplasms
adenoma
transphenoidal approach
