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目的研究额下入路(额下组)和单鼻孔经蝶入路(单鼻孔组)手术切除鞍内鞍上型垂体腺瘤的疗效和特点。方法回顾性分析27例经额下入路与38例单鼻孔经蝶入路手术切除鞍内鞍上型垂体腺瘤患者的临床资料,对比两组患者手术前后内分泌、影像学和临床表现。结果额下组肿瘤全切17例,次全切7例,部分切除3例;单鼻孔组全切28例,次全切8例,部分切除2例。视力视野障碍恢复正常或明显改善者额下组19例,单鼻孔组33例。患者术后泌乳停止或减少额下组8例,单鼻孔组14例。额下组术后出现尿崩9例,术侧视力下降3例,嗅神经损伤12例。单鼻孔术后脑脊液鼻漏4例,尿崩11例。结论对于手术治疗鞍内鞍上型垂体腺瘤来讲,额下入路和单鼻孔经蝶入路均是两种有效的手术方式,单鼻孔入路在肿瘤切除后内分泌改善方面和残存垂体功能保护方面优点更明显,创伤小,手术时间短,并发症少。
Objective To study the curative effect and characteristics of surgical treatment of suprasellar pituitary adenoma in the inferior frontalis (frontal frontispiece) and the single nostril transsphenoidal approach (single nasal hole). Methods The clinical data of 27 patients with suprasellar suprasellar pituitary adenoma resected by inferior frontal approach and 38 patients with single nostril transsphenoidal approach were retrospectively analyzed. The endocrine, radiographic and clinical features of the two groups were compared before and after operation. Results The total amount of tumor in the lower group was 17, total subtotal 7, partial 3, single nostril 28, subtotal 8, and partial 2. Visual acuity disorders returned to normal or significantly improved in front of the group of 19 patients, single nostril group of 33 patients. Patients with postoperative lactation stopped or reduced in the lower group of 8 patients, single nostril group of 14 patients. In the lower group, there were 9 cases of diabetes insipidus, 3 cases of decreased visual acuity and 12 cases of olfactory nerve injury. Nasal leakage after single nostril surgery in 4 cases, diabetes insipidus in 11 cases. Conclusions For surgical treatment of supraspinatus pituitary adenoma, the inferior frontal approach and the single nostril transsphenoidal approach are two effective surgical approaches. The single nostril approach can improve the endocrine function after tumor resection and the residual pituitary function Protection advantages more obvious, less trauma, shorter operative time, fewer complications.