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目的 :探讨经鼻中隔 -蝶窦垂体瘤切除术的术中定位方法及其优缺点。方法 :3 3例垂体瘤经鼻中隔 -蝶窦手术 ,术前均行头颅平片、鞍区冠状位CT及MRI成像检查 ,术中应用显微镜 19例 ,内窥镜 7例 ,显微神经导航 5例 ,显微镜与内窥镜结合手术 2例 ;术中行X线定位检查 14例。结果 :术中准确定位蝶窦及鞍底 3 0例 ,3例出现偏差 ,开放蝶窦或鞍底前X线定位、神经导航及内窥镜手术无出现偏差。结论 :术前完善的检查必不可少 ,术中X线检查定位有助于准确定位蝶窦及鞍底 ,经济实用 ;内窥镜及显微神经导航技术较单纯显微镜有优势 ,但需相关的设备和技术 ,且医疗费用昂贵。
Objective: To investigate the method of intraoperative localization of nasal septum and sphenoid sinus pituitary tumor and its advantages and disadvantages. Methods: Thirty-three cases of pituitary adenomas were treated by nasal septum-sphenoid sinus surgery. All the patients underwent cranial plain radiography and coronal CT and MRI of the sella region. There were 19 cases of microscopy, 7 cases of endoscopy and 5 cases of microsurgical navigation Cases, microscopy and endoscopy combined surgery in 2 cases; line X-ray positioning 14 cases. Results: The intraoperative accurate positioning sphenoid sinus and sella 30 cases, 3 cases of deviation, open sphenoid or saddle anterior X-ray positioning, neuro-navigation and endoscopic surgery without deviation. Conclusion: The perfect preoperative examination is essential, intraoperative X-ray examination helps to accurately locate the sphenoid sinus and the saddle, economical and practical; endoscopic and microscopic nerve navigation technology has advantages over simple microscope, but need to be related Equipment and technology, and medical costs are expensive.