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目的为了提高大型、巨大型垂体腺瘤经口鼻蝶窦显微手术全切除率。方法15例患者手术中采用美国Datex.ohmeda7100型麻醉机。静脉和吸入复合麻醉,呼吸机控制呼吸。肿瘤切除过程中发现鞍隔下降不满意时,关闭机械通气开关,行人工通气控制呼吸分次行短暂气道加压使气道压达到50~70cmH2O。术中观察鞍隔下降程度。术后3个月复查MRI评价肿瘤切除程度。结果15例患者中14例鞍隔下降达到扩大蝶鞍的鞍中或鞍底水平。术后复查MRI13例患者肿瘤全切除,全切除率86.7%。所有患者视力、视野有明显改善。结论在大型、巨大型垂体腺瘤经蝶窦切除术中应用短暂气道加压法安全、有效,可以提高肿瘤全切除率。
Objective To improve the large, large pituitary adenoma by microsurgery of the mouth and sphenoid sinus resection rate. Methods Fifteen patients underwent surgery using the American Datex.ohmeda7100 anesthesia machine. Venous and inhalation anesthesia, breathing machine control breathing. During the resection of the tumor, when the saddle septum is not satisfactorily found, the mechanical ventilation switch is turned off and the artificial airway control breathing sub-series is performed with brief airway pressure to bring the airway pressure to 50-70cmH2O. Intraoperative observation of septal declination. 3 months after the review MRI evaluation of tumor resection level. Results In 15 patients, 14 cases of septum decreased to achieve the saddle or saddle end of the enlarged sella. After resection MRI 13 cases of patients with total tumor resection, total resection rate of 86.7%. All patients with visual acuity, visual field significantly improved. Conclusions Transient airway pressure is a safe and effective method for transsphenoidal surgery in large and huge pituitary adenomas, which can improve the total resection rate.