摘要
目的观察经中鼻甲基板水平部开放后筛加鼻中隔入路经蝶窦垂体瘤手术的效果.方法 50例垂体瘤患者内镜下经一侧或双侧中鼻甲基板开放后筛后加鼻中隔后段切除暴露蝶窦前壁,继之充分开放蝶窦前壁,显露鞍底切除垂体瘤.记录手术时间、出血量、住院时间、并发症(脑脊液漏、尿崩、颅内感染、神经功能损伤),术后鼻腔功能以及肿瘤全切和死亡情况.结果本组患者平均手术时间2.2h,出血量245 ml,术后平均住院时间6.2d,术中12例患者出现脑脊液漏,即时修补后无持续脑脊液漏发生;尿崩3例;嗅觉减退/丧失12例;术后垂体功能低下4例;无视神经损伤及颅内感染.因肿瘤压迫或卒中导致的视力下降术后均有改善.肿瘤全切率86%(43/50),无死亡病例.结论内镜下经中鼻甲基板水平部开放后组筛窦加鼻中隔后段部分切除后充分开放蝶窦前壁显露鞍底及蝶窦内解剖结构,继而切除垂体瘤的方法,视野清晰、肿瘤全切率高、微创安全、对鼻腔鼻窦功能保护好.值得临床推广应用.
Objective To observe the effect of transsphenoidal pituitary adenoma removal via posterior ethmoid and septum approach by opening horizontal part of middle turbinate basal lamella. Methods 50 patients with pituitary adenoma were enrolled in this study. The anterior wall of sphenoid sinus was endoscopically exposed and fully opened by lateralizing the posterior part of middle turbinate after removing horizontal part of basal lamella and posterior septum, and then the pituitary adenoma was removed through the sellar floor. Time of operation, volume of blood loss, length of hospital stay, complications ( cerebrospinal fluid leakage, diabetes insipidus, intracranial infection, neurological impairment ), postoperative nasal function, total resection of the tumor and death were recorded. Results The average operation time was 2. 2 hours with an average blood loss volume of 245 ml. The average hospitalization time was 6. 2 days, and intraoperative cerebrospinal fluid leakage occurred and was cured with simultaneous repair in 12 cases. The cases numbers of postoperative diabetes insipidus, hyposmia/anosmia and hypopituitarism were 3, 12 and 4, respectively. Visual acuity due to tumor compression or stroke got improved after operation without intraoperative optical nerve damage. Total tumor resection was achieved in 43 cases without death. Conclusion With advantages of clear surgical field, high total resection rate of tumor, minimal invasion, high safety as well as proper protection of nasal function, the endoscopic surgery of pituitary adenoma via posterior ethmoid and septum approach after the opening the horizontal part of middle turbinate basal lamella is worth popularizing and applying in clinic.
作者
曹守明
周小英
付云龙
李晓仙
宁金梅
吕正超
赵宁辉
吴海莺
CAO Shou-ming;ZHOU Xiao-ying;FU Yun-long;LI Xiao-xian;NING Jin-mei;LU Zheng-chao;ZHAO Ning-hui;WU Hai-ying(Department of Otolaryngology,the 2nd Affiliated Hospital of Kunming Medical University,Kunming 650101,China;Department of Otolaryngology,People's Hospital of Mengzi City,Mengzi 661100,China;Department of Otolaryngology,People's Hospital of Qujing City,Qujing 655000,China;Department of Neurosurgery,the 2nd Affiliated Hospital of Kunming Medical University,Kunming 650101,China)
出处
《中国耳鼻咽喉颅底外科杂志》
CAS
2019年第3期261-265,共5页
Chinese Journal of Otorhinolaryngology-skull Base Surgery
基金
云南省应用基础研究(昆医联合专项)[2017FE467(-178)]
关键词
垂体瘤
经鼻蝶窦入路垂体瘤切除术
内镜
中鼻甲基板
Pituitary adenoma
Endonasal transsphenoidal pituitary adenoma resection
Neuroendoscope
Middle turbinate basal lamella
