内镜下单鼻孔蝶窦入路切除鞍内病变

目的总结内镜下经单鼻孔蝶窦入路切除鞍内病变的疗效与手术经验。方法回顾性分析136例鞍区病变患者的临床资料及手术方法，其中垂体腺瘤116例，Rathke囊肿16例，颅咽管瘤4例，均采用神经内镜下经单鼻孔蝶窦入路鞍内切除病变。结果垂体腺瘤116例，肿瘤全切90例（77．6％），次全切26例（22．4％）；Rathke囊肿16例，均全切16例（100％）；颅咽管瘤4例，全切1例（25％），次切3例（75％）。术后视力及视野改善83例，内分泌指标恢复正常95例。脑脊液鼻漏7例，2周后自愈；一过性尿崩25例。本组无死亡病例，无颅内出血等其他并发症。结论神经内镜下经单鼻孔蝶窦入路手术切除鞍内病变具有安全、视野清晰、术时短、肿瘤切除更为彻底及术后并发症少等优点，是较理想的经蝶手术术式。

Resection of sellar region tumors through endoscopic transsphenoidal approach

Objective To evaluate the therapeutic effect and review experience of surgical resection of sellar region tumors through endoscopic transsphenoidal approach. Methods Clinical data of 136 patients with sellar region tumors and the applied surgical techniques were analyzed retrospectively. The lesions included pituitary adenoma （116 cases ）, Rathke ＇ s cyst （16 cases ）, and craniopharyngioma （4 cases ）. All the tumors were resected via endoscopic transsphenoidal approach. Results Of 116 cases of pituitary adenomas, total tumor removal was achieved in 90 cases （77. 6 % ） , subtotal removal in 26 cases （22. d % ） . Rathke＇s cyst was totally removed in all 16 cases （ 100 % ） . As for the craniopharyngioma , total removal was achieved in one case （ 2 5 % ） , partial removal in 3 cases （ 7 5 % ） . After operation , visual acuity and visual field improved in 83 patients. Endocrine parameters returned to normal level in 95 cases. Seven cases developed temporary cerebrospinal rhinorrhea and were cured in 2 weeks; transient diabetes insipidus occurred in 18 cases. No mortality and no serious complications such as intracranial hemorrhage occurred. Conclusion Endoscopic transsphenoidal approach is a favorable surgical mode for seUar region tumors due to its advantages in term of direct approach, short operative time, minimal invasion, thorough resection of tumor and few complications.