垂体腺瘤切除术中内窥镜的应用(附13例病例分析)

目的：探讨内窥镜技术在直接经鼻蝶垂体腺瘤切除术中的应用。方法：２０００年３月～２０００年８月在１３例直接经鼻蝶垂体腺瘤切除术中应用内窥镜技术，其中垂体微腺瘤３例、大腺瘤１０例。内窥镜直接由单鼻孔进入，８例在鼻前庭作切口、５例未作鼻腔皮肤粘膜切口，内窥镜下显露蝶窦开口，找开蝶窦，经鞍底切除肿瘤。结果：１３例患随访１个月～５个月，平均３个月。术前１０例内分泌检查异常患术后复查激素水平均降至正常：ＭＲＩ术前、后对照，１０例肿瘤全部切除，３例在海绵窦残余部分肿瘤。术后发生暂时性尿崩症３例、１例发生脑脊液鼻漏，经二次手术修补治愈。结论：在直接经鼻蝶垂体腺瘤手术中应用内窥镜技术有利于良好显露术野和彻底切除肿瘤，疗效满意，并发症少，值得进一步推广。

USE OF ENDOSCOPE IN PITUITARY ADENOMA RESECTION

Objective:To use endoscopic technique in direct transnasal transsphenoidal pituitary adenoma resection.Methods:From March 2000 to August 2000,endoscopic technique was used in direct transnasal transsphenoidal pituitary adenoma surgery for 13 cases(3 microadenoma,10 macroadenoma).By direct transnasal approach,nasal vestibule incisions were made in 8 cases,no incision was made in the other 5 cases.The endoscopic technique was used in exposing and opening anterior wall of sphenoidal sinus, observing interior structure of sinus,opening sellae base and detecting residual tumor in and above sellae.Results:All patients were followed up for 3 months in average.The symptoms of vision defects in 4 patients out of 6 were improved.The increased hormone level in all 10 patients were decreased to normal after operation.By postoperative MRI detection,the adenomas in 10 patients were removed completely,part of the adenomas were left in carvernous sinuses in 3 patients.Temporary diabetes insipidus were observed in 3 patients.One postoperative CSF leakage was repaired succesfully by another operation.Conclusion:Using endoscopic technique in direct transnasal transsphenoidal pituitary adenoma resection is helpful to exposing operation field and removing adenomas completely.The effects were satisfactory without severe complications.