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目的探讨鼻内镜外科技术在前颅底及蝶鞍区肿瘤治疗中的方法及作用。方法2004年11月至2008年6月对16例侵犯前颅底与蝶鞍区的肿瘤行鼻内镜手术,其中1例采用眶内容物剜除术加鼻内镜联合入路,所有手术均于全麻下进行,病理类型包括垂体腺瘤6例,内翻性乳头状瘤5例,中分化鳞癌1例,脊索瘤1例,原始神经外胚层瘤1例,嗅母细胞瘤1例,骨化纤维瘤1例。术后随访3个月~4年。结果经术中镜下、术后内镜或者影像学检查证实15例肿瘤均被全部切除,1例脊索瘤为大部切除,1例垂体腺瘤患者术后出现脑脊液鼻漏,经二次手术修补及规范治疗后痊愈。无颅内出血、感染及死亡病例。结论内镜经鼻入路能够充分显露和切除前颅底及蝶鞍区肿瘤,可以更好地辨认深部结构,视觉效果好,是一种较好的手术入路。但要求术者熟练掌握解剖学知识,具备娴熟的手术技巧,先进的仪器设备以及必要的综合处理的经验。
Objective To explore the methods and effects of endoscopic surgery in the treatment of tumors in the anterior skull base and sella region. Methods From November 2004 to June 2008, 16 cases of tumors which infiltrated the anterior skull base and the sellar region underwent endoscopic sinus surgery. One case was treated by orbital debridement combined with endoscopic sinus surgery, and all the operations Under general anesthesia, the pathological types include 6 cases of pituitary adenoma, 5 cases of inverted papilloma, 1 case of differentiated squamous cell carcinoma, 1 case of chordoma, 1 case of primitive neuroectodermal tumor, 1 case of olfactory blastoma , Ossification fibroma in 1 case. Follow-up 3 months to 4 years. Results All the 15 tumors were excised by endoscopy or postoperative endoscopy or imaging examination. One patient had partial removal of chordoma and one patient had pituitary adenoma. Cerebrospinal fluid rhinorrhea occurred after operation. After secondary surgery Repair and standard treatment after recovery. No intracranial hemorrhage, infection and deaths. Conclusion Endoscopic transnasal approach can fully reveal and resect tumors of anterior skull base and sella region, which can better identify the deep structure and have good visual effects. It is a good surgical approach. However, the surgeon is required to have good knowledge of anatomy, skilled surgical skills, advanced equipment and necessary integrated treatment experience.