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目的:探讨经鼻蝶手术后复发或残留的垂体瘤再次经单鼻孔直达蝶窦入路显微外科手术的技术方法与疗效。方法:我科2001年8月至2005年8月对经鼻蝶手术后复发或残留的32例垂体瘤进行了经单鼻孔直达蝶窦入路显微外科再次手术治疗。结果:14例(43.8%)肿瘤获全切除,10例(31.2%)肿瘤达到次全切除,8例(25.0%)肿瘤仅获部分切除,无手术死亡。在垂体激素异常增高的13例功能性垂体腺瘤中,6例激素水平降至正常,3例激素水平下降>50%,4例激素水平下降<50%。24例术后随访观察6~48个月,8例(8/9)头痛消失或减轻;21例(21/22)视力、视野障碍改善;5例(5/7)肢端肥大症减轻;3例(3/4)溢乳停止,月经恢复。结论:经单鼻孔直达蝶窦入路显微外科手术最大限度的利用了鼻腔的自然间隙,具有入路直接、创伤轻微和并发症少等优点;尽管有一定难度,但仍然是治疗经鼻蝶手术后复发或残留垂体瘤的一种安全有效的微创方法。
Objective: To explore the technique and efficacy of microsurgical operation of recurrent or residual pituitary tumor after nasal butterfly surgery through the single nostril directly into the sphenoid sinus. Methods: From August 2001 to August 2005, 32 cases of pituitary adenomas recurred or remained after transnasal surgery were treated by microsurgery with single nostril direct transsphenoidal approach. Results: Fourteen cases (43.8%) underwent total resection, 10 cases (31.2%) achieved subtotal resection, and 8 cases (25.0%) underwent partial resection without surgical death. In 13 cases of functional pituitary adenomas with abnormally elevated pituitary hormones, 6 were normalized to hormone levels, 3 were reduced by> 50% and 4 were reduced by <50%. Twenty-four patients were followed up for 6 to 48 months. Eight patients (8/9) had headache disappeared or reduced. 21 patients (21/22) had visual acuity and visual field improvement. Acromegaly was relieved in 5 patients (5/7) 3 cases (3/4) galactorrhea stopped, menstruation recovered. CONCLUSION: Microsurgery via single nostril direct sphenoid sinus maximizes the use of the natural space of the nasal cavity, with the advantages of direct access, minor trauma and fewer complications. Although there is some difficulty, it is still the treatment of the nasal valve A safe and effective minimally invasive method for recurrence or residual pituitary tumor after surgery.