摘要
目的总结单鼻孔经蝶窦入路显微手术治疗鞍区囊性垂体病变的经验。方法 2006～2010年,显徽镜下单鼻孔经蝶窦入路治疗15例囊性垂体病变,病变直径11～28 mm,其中>20 mm者6例。将鼻窥器缓慢插入右鼻孔向上经中鼻甲直至蝶窦前壁,横行切开鼻中隔黏膜约1.5 cm,保持窥器尖呈闭合状态向对侧偏移,使鼻中隔骨折移位。然后将窥器张开,可见中线骨性隆起结构蝶嵴及两侧蝶窦开口。凿除蝶窦前壁约1.0～1.5 cm,显露蝶窦腔,咬除蝶窦分隔,剥离电凝蝶窦黏膜,显露凸形鞍底,凿开并扩大至1.2～1.5 cm骨窗即见硬脑膜,电凝硬膜后穿刺,证实病变后"十"字切开,显露病变并予钳取和刮除。结果手术过程顺利,病变全切除14例,次全切除1例。病理结果为垂体脓肿4例,Rathke囊肿7例,囊性垂体腺瘤4例。无死亡及病残,术后无脑脊液鼻漏。1例囊性垂体腺瘤次全切除患者术后行伽玛刀治疗,随访10个月未见肿瘤增大。余14例随访8～19个月,平均14个月,无复发。结论鞍区囊性垂体病变术前鉴别诊断虽然较困难,但仍有很多特征可以鉴别;应用单鼻孔经蝶窦入路可取得简捷、安全、高效的治疗效果。
Objective To summarize our experience in endoscopic endonasal transsphenoidal approach for the treatment of cystic pituitary lesions in the sella region. Methods We retrospectively analyzed 15 patients with cystic pituitary lesions, who received endoscopic surgery in our hospital from 2006 to 2010. The diameter of the lesions ranged from 11 to 28 mm （ 〉 20 mm in 6 cases）. Through the right nostril, we inserted an endoscope into the anterior wall of sphenoid sinus via the middle nasal turbinate, and then a 1.5-cm incision was made on the nasal septum. With a fracture of the bony septum, a space was developed between the bilateral nasal mucosa and bony septum to the sphenoid sinus. Then, the face of the sphenoid sinus was exposed. The rest of the bony septum, anterior sphenoid sinus wall, and the sphenoid mucosa were removed successively to show the sella bottom （ 1.2 - 1.5 cm wide）. After confirming the lesion by dural puncture, a cross incision was made on the dura so that to remove the lesion. Results The lesions were totally removed in 14 cases, and subtotally resected in 1 case. Pathological findings showed pituitary abscess in 4 cases, Rathke cyst in 7 cases, and cystic pituitary adenoma in the other 4. No death, disability or cerebrospinal fluid rhinorrhea occurred after the surgery. The patients who underwent subtotal resection of the lesion （cystic pituitary adenoma） received gamma knife treatment afterwards, and then received a 10-month follow-up, during which the tumor was not developed. The other 14 cases were followed up for 8 to 19 months with a mean of 14 months; none of them had recurrence. Conclusions Though difficult, it is still possible to identify cystic pituitary lesions in the sella region preoperatively. Endoscopic endonasal transsphenoidal approach is simple, safe, and effective for the treatment of cystic pituitary lesions.
出处
《中国微创外科杂志》
CSCD
2012年第12期1121-1123,1126,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
单鼻孔
蝶窦入路
显微手术
垂体腺瘤
Single nostril
Transsphenoidal approach
Microsurgery
Pituitary adenoma
