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目的探讨经单鼻孔蝶窦入路显微手术垂体腺瘤切除的方法和效果。方法对45例垂体腺瘤患者采用经单鼻孔蝶窦入路显微手术切除6例微腺瘤及39例大腺瘤,其中泌乳素(PRL)腺瘤18例,生长激素(GH)腺瘤8例,混合性(PRL+GH或PRL+ACTH)腺瘤12例,无功能性腺瘤7例。结果显微镜下全切除43例,次全切除2例。术后一过性尿崩症28例,经治疗1周左右恢复。无手术死亡、脑脊液鼻漏、术区出血及脑膜炎等并发症。术后平均住院8 d,全组病例术中未输血;随访1~5年,1例复发。结论单鼻孔经蝶窦入路较传统经蝶入路具有安全、简便、微创、术后并发症少、恢复快、效果满意等优点,是鞍内肿瘤切除的良好径路。
Objective To investigate the method and effect of microsurgical pituitary adenoma excision through the single nostril sphenoid sinus approach. Methods A total of 45 patients with pituitary adenomas underwent microsurgical excision of 6 cases of microadenomas and 39 cases of large adenomas by microsurgical approach. Among them, PRL adenomas were found in 18 cases and growth hormone (GH) 8 cases, mixed (PRL + GH or PRL + ACTH) adenoma in 12 cases, 7 cases of non-functional adenoma. Results Microsurgical resection in 43 cases, subtotal resection in 2 cases. Postoperative transient diabetes insipidus in 28 cases, after treatment for about 1 weeks recovery. No surgical death, cerebrospinal fluid rhinorrhea, bleeding and meningitis surgery and other complications. The average postoperative hospitalization 8 d, no transfusion of blood transfusion in all the cases; 1 to 5 years follow-up, 1 case of recurrence. Conclusion Single nostril transsphenoidal approaches are safe, simple, minimally invasive, less postoperative complications, quicker recovery and satisfactory results than traditional transsphenoidal approach. It is a good way to excision of tumors in the saddle.