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目的探讨垂体腺瘤经蝶窦的手术途径和处理策略。方法回顾性总结1992年~2004年68例垂体腺瘤经蝶手术的临床资料和疗效,术前行蝶窦断层X片、CT及MR检查,充分地了解蝶窦的气化程度和蝶窦的分隔。其中经唇下-鼻中隔-蝶窦入路7例;经鼻前庭-鼻中隔-蝶窦入路53例;经单鼻孔-蝶窦直接入路8例。结果全切除48例(70.6%),大部分切除18例(26.5%),部分切除2例(2.9%)。无脑脊液漏和颅内感染发生;暂时性尿崩症2例,无永久性尿崩;未发生神经功能缺损,无手术死亡。随访13年内分泌症状56例中,28例恢复正常,20例改善,8例同术前。结论经鼻前庭-鼻中隔-蝶窦入路显露理想,适应于各种类型垂体腺瘤;经单鼻孔-蝶窦直接入路省时、简捷,尤其适应于中小型垂体腺瘤;经唇下-鼻中隔-蝶窦入路显露理想,但有创伤大、耗时长等缺点。术前熟悉蝶窦的分隔是预防经蝶手术“迷途”的关键。
Objective To investigate the surgical approach and treatment strategy of pituitary adenoma through the sphenoid sinus. Methods The clinical data and curative effects of 68 cases of pituitary adenoma transsphenoidal surgery from 1992 to 2004 were retrospectively reviewed. X-ray, CT and MR examination of sphenoid sinus were performed before operation to fully understand the degree of gasification of the sphenoid sinus and the sphenoid sinus Separated. Among them, there were 7 cases under the lip - nasal septum - sphenoid sinus approach; 53 cases through the nasal vestibule - nasal septum - sphenoid sinus approach; 8 cases through the single nostril - sphenoid sinus approach. Results Total resection in 48 cases (70.6%), the majority of resection in 18 cases (26.5%), partial resection in 2 cases (2.9%). No cerebrospinal fluid leakage and intracranial infection occurred; 2 cases of transient diabetes insipidus, no permanent diabetes insipidus; no neurological deficit, no operative death. During the follow-up of seizure symptoms in 13 years, 28 cases returned to normal, 20 cases improved, and 8 cases were the same as preoperative. Conclusions The nasal vestibular - nasal septum - sphenoid sinus approach is ideal for various types of pituitary adenomas. It is a simple, time-saving and simple procedure for direct and indirect management of small and medium sized pituitary adenomas via the single nostril and sphenoid sinus. Nasal septum - sphenoid sinus approach revealed the ideal, but trauma, time-consuming and other shortcomings. Preoperative familiar sphenoid separation is the key to preventing “lost” transsphenoidal surgery.