脑内窥镜辅助下单鼻孔入路经蝶窦切除垂体腺瘤手术体会

目的探讨内窥镜辅助下经蝶窦单鼻孔入路垂体腺瘤切除手术的可行性、优缺点、手术适应证和临床应用价值。方法采用MRI明确诊断，运用直径4mm的0°、30°内窥镜监视下经单鼻孔蝶窦入路对38例垂体腺瘤进行手术切除。结果29例垂体腺瘤得到完全切除，6例近全切除，3例部分切除。26例术前视力损害的患者中，25例术后均有不同程度的恢复，1例无改变。术后1例出现永久性尿崩伴垂体功能低下者需药物治疗。术后未见脑脊液鼻漏、颅内感染等并发症发生。结论内窥镜辅助下经蝶窦单鼻孔入路垂体腺瘤切除手术是一个简便、安全、微创的新技术，只要正确掌握手术适应证，就可以获得满意的治疗效果。

Endoscope-assisted Microsurgery through Transmononasal Transsphenoidal Approach for Pituitary Adenomas

Objectives To explore the feasibility, merits, demerits, indication and clinical value of endoscope-assisted micro- surgery through transmononasal transsphenoidal approach for pituitary adenomas. Method The endoscope-assisted microsurgery through transmononasal transsphenoidal approach was performed with 0°and 30° rigid endoscope of 4 mm in diameter in 38 patients with pituitary adenomas, which were definitely diagnosed as by MRI. Results Of 38 patients with pituitary adenomas, 29 underwent total resection of the tumors, 6 subtotal and 3 major. The different recovery of eyesight in degree was observed one week after the operation in 25 of 26 patients with disorder of eyesight before the operation. All the patients were significantly improved in the symp-toms. The complications included lower pituitary function in 2 patients （1 had permanent diabetes insipidus） and temporary diabetes insipidus in 7 patients. There were no cerebrospinal fluid leak and intracranial infection in all the patients. Conclusions Endoscope-assisted microsurgery through transendonasal transsphenoidal approach is a new, simply, safe and minimally invasive procedure for removing pituitary adenomas. The improvement of endoscope, surgical instruments and operative techniques will facilitate its clinical application.