鼻内镜联合显微镜行蝶窦及经蝶鞍区微创手术

目的探讨经单侧鼻腔直接入路行蝶窦及经蝶鞍区微创手术的方法。方法鼻内镜下用Hardy′s撑开器外移中鼻甲，扩大鼻腔，直达并开放蝶窦前壁，联合显微镜切除病变。结果12例孤立性蝶窦炎术后窦口开放良好，症状消失。9例蝶窦囊肿、脑膜瘤一次手术切除。1例蝶窦骨瘤术后症状消失。1例外伤性失明视神经管减压，术后视力无恢复。33例垂体瘤中 18例行全切除术，12例行次全切除术，3例行大部分切除术，术后补充X刀治疗。56例术后随访6个月～3.5年，蝶窦炎、蝶窦囊肿、脑膜瘤、蝶窦骨瘤术后无复发，3例垂体腺瘤复发，无颅内及鼻腔并发症。结论鼻内镜联合显微镜经单侧鼻腔直接入路行蝶窦及经蝶鞍区手术，创伤小、时间短、出血少、并发症少、效果好，是目前较好的蝶窦及经蝶鞍区微创术式。

Sphenoid sinus and trans-sphenoid surgery under nasal endoscopy and microscopy

To explore the method of sphenoid sinus and trans-sphenoid surgery by a direct hemi-nasal approach. MethodsWith nasal endoscopy and microscopy, the middle conchas were moved outside by Hardy′s stretcher, the nasal cavities were broadened, the frontal walls of sphenoid sinus were opened, and the lesions were removed. Results12 cases of simple sphenoid sinusitis had the aperture well opened and then symptoms disappeared. 9 cases had the sphenoid sinus cyst and meningoma removed. 1 case of sphenoid sinus osteoma recovered well. 1 case of traumatic ablepsia received decompression of the optic canal but no recovery was found after the operation. In 33 cases of pituitary adenoma, 18 tumor were totally removed, 12 were sub-totally removed, and 3 were fully removed, and they were all further treated by post-operative X-knife. During a postoperative follow-up of half to 3.5 years, there were no recurrences in cases of sphenoid sinusitis, sphenoid sinus cyst, meningoma or phenoid sinus osteoma. Pituitary adenoma recurred in 3 cases. All cases had no intracranial and nasal complications. ConclusionSphenoid sinus and trans-sphenoid surgeries by a direct hemi-nasal approach with nasal endoscopy and microscopy have advantages of minimal invasion, less time and bleeding, few complications and good effect.