摘要
目的比较三种不同的经蝶入路切除垂体腺瘤手术方式的优缺点。方法对80例垂体腺瘤患者采用经蝶窦入路三种不同方式切除肿瘤,其中经唇下-鼻中隔-蝶窦入路(简称经唇下入路)5例,经蝶窦直接入路7例,经黏膜下-鼻中隔-蝶窦入路(简称鼻中隔入路)68例。结果经唇下入路5例,需切开上唇黏膜,解剖鼻前嵴、鼻中隔软骨及骨性鼻中隔,并咬除骨性鼻中隔,操作复杂,手术创伤大;经蝶窦直接入路7例,不需解剖上述结构,操作简单,可将鼻窥镜直接插入鼻腔,撑开鼻窥镜时使蝶窦前壁与鼻中隔根部转折处骨质和黏膜断开,通过寻找骨折处残余骨嵴形成的中线标记,找到蝶窦开口再进入蝶窦,但缺乏经验的手术者容易迷路,经该入路手术的7例中有2例迷路,经术中C臂X线透视机帮助定位后才找到蝶窦;经鼻中隔入路68例,在显微镜直视下切开术侧鼻中隔黏膜,在黏膜和鼻中隔骨质的自然间隙中钝性分离至鼻腔底部,顺着分开的间隙插入鼻窥镜,撑开鼻窥镜使蝶窦前壁与鼻中隔根部转折处骨质断开,不撕开黏膜,通过残余骨嵴标记找到蝶窦开口再进入蝶窦,操作过程紧贴骨性鼻中隔进行,解剖标志清楚,不易离开中线,不易迷路,68例均顺利进入蝶窦完成手术。本组80例中,肿瘤全切和次全切69例,大部分切除8例,部分切除3例。结论经鼻中隔入路切除垂体腺瘤,解剖层次清晰、安全、有效、容易掌握。
Objective To explore the merits and demerits of transsphnoidal microsurgery through three different approaches for the pituitary adenomas. Method Of 80 patients with pituitary adenomas undergoing transsphnoidal microsurgery,5 directly underwent the microsurgery through sublabio-septo-sphenoidal approach（SLSSA） ,7 directly through the sphenoidal sinus approach（SSA） ,and 68 through the rhinoseptal approach（RSA） . Results The surgical trauma induced by the microsurgery through SLSSA,which was relatively complex procedure,was more severe than that induced by the microsurgery through SSA or RSA in the patients with pituitary adenomas. The microsurgery directly through SSA was relatively simple procedure,but the inexperienced operator doing it easily ＂went astray＂ during the operation. The sphenoidal sinuses were not found until X-ray examination in 2 patients undergoing the microsurgery through SSA. The operators did not ＂go astray＂ due to clear anatomic landmark during the microsurgery through RSA,which produced relatively little operation side injury. Of 80 patients with pituitary adenomas,69 received total and subtotal resection of the adenomas,8 greatly part and 3 part. Conclusions The transsphnoidal microsurgery through RSA,which has many advantages including the clear anatomic structures,safety,effectiveness,easy grasp of its technique and so on,is suitable for most patients with pituitary adenomas.
出处
《中国临床神经外科杂志》
2011年第3期148-150,共3页
Chinese Journal of Clinical Neurosurgery
关键词
垂体腺瘤
显微外科
手术入路
鼻中隔入路
蝶窦
Pituitary adenoma
Microsurgery
Operative approach
Rhinosepital approach
Sphenoidal sinus
