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目的总结神经内镜下经鼻-蝶窦入路切除垂体瘤的手术经验及体会。方法对76例垂体腺瘤患者行内镜下经鼻-蝶窦入路手术切除,观察手术情况、术后并发症,随访结果及术后病理情况。结果肿瘤全切71例(93.4%),次全切除3例(3.9%),大部分切除2例(2.6%);手术时间1.0～2.5h,平均1.5h。术后平均住院5d,无死亡者。57例获得平均6个月的随访,39例视力、视野障碍患者中,31例恢复至正常水平,8例明显改善。64例激素水平明显增高患者中,48例随诊降至正常水平。2例术后1年复发,再次在显微镜下并应用神经内镜辅助行手术切除,术后随访2年未再复发。结论单纯神经内镜经鼻-蝶窦入路切除垂体腺瘤疗效满意,对正常解剖结构损伤小、手术时间短、肿瘤全切除率高、患者住院时间短、病情恢复快,可作为治疗首选。
Objective To summarize the surgical experience and experience of endoscopic transnasal-sphenoid sinus surgery for resecting pituitary tumors. Methods 76 patients with pituitary adenomas underwent endoscopic nasal-sphenoid sinus surgery. The operative conditions, postoperative complications, follow-up results and postoperative pathology were observed. Results Totally 71 cases (93.4%) underwent total subtotal resection, 3 cases (3.9%) underwent subtotal resection and 2 cases (2.6%) underwent resection. The operation time was 1.0-2.5 hours (average 1.5 hours). The average postoperative hospitalization 5d, no deaths. Fifty-seven patients were followed up for an average of 6 months. Of 39 patients with visual acuity and visual field disorders, 31 returned to normal and 8 improved significantly. 64 cases of patients with significantly higher hormone levels, 48 cases were followed-up to normal levels. Two patients relapsed one year after operation, again under the microscope and assisted by endoscopic neurosurgical resection, no recurrence after 2 years of follow-up. Conclusions Simple endoscopic transnasal - sphenoid sinus approach resection of pituitary adenoma is satisfactory, with less damage to the normal anatomical structure, shorter operative time, high total excision rate, shorter hospital stay and faster recovery of disease.