内镜下经鼻蝶入路垂体腺瘤切除技术与器械的改进

目的通过手术技术和器械的改进，提高神经内镜下经单鼻孔鼻中隔蝶窦入路垂体腺瘤切除术的手术效率。方法采用神经内镜经单鼻孔鼻中隔蝶窦入路切除288例垂体腺瘤，术中无需寻找蝶窦开口，以中鼻甲为解剖标志，用单极电凝纵行切开鼻中隔黏膜，髓核钳咬除部分骨性鼻中隔和蝶窦前壁，手术结束时，鼻黏膜复位，无需再填塞鼻腔。结果患者平均手术时间70min，手术时间最短的仅30min，术中无脑脊液漏，术后3～5d出院，效果满意。结论神经内镜下经单鼻孔鼻中隔蝶窦入路垂体腺瘤切除术手术和住院时间短，出血少，鼻腔内黏膜结构保护良好，术后并发症少，可达到术后无手术痕迹的效果，手术器械的改进与正确应用是提高手术效率的关键。

Improvement of surgical technique and instruments for pituitary adenoma resection via the neuroendoscopic-assisted endonasal transsphenoidal approach

Objective To increase efficacy of pituitary adenoma resection via the neuroendnscopic-assisted endonasal transsphenoidal approach by improving surgical technique and instnnnents. Methods A total of 288 cases with pituitary adenomas were resected via the neuroendoscopic-assisted endonasal transsphenoidal approach. In the operation, the middle nasal concha was considered as anatomic landmark without need searching for sphenoidal nstium. After the nasal septum mucosa was longitudinally incised by monopolar dectrocoagulation, parts of ostenseptum and anterior wall of sphenoid sinus were removed. Only resettlement of the nasal sepmm mucosa was enough after tumor removal and nasal packing was not necessary. Results The mean operative time was 70 min and the minimal one was only 30 min. No intraoperative cerebrospinal fluid leakage ocurred. All patients had good curative effects and discharged within 3 - 5 d. Conclusion Neuroendoscopic-assisted pituitary adenoma resection via single nostril, nasal septum, transsphenoidal approach has the advantages of shortened operative time and hospital stay, less hemorrhage, good preservation of nasal mucosa and less postoperative complications. The key to improve the operative efficiency is the improvement and reasonable application of surgical instruments.