内窥镜经鼻内蝶窦垂体腺瘤切除术

目的：探讨内窥镜经鼻－蝶窦入路切除垂体腺瘤,尤其是巨大垂体腺瘤的可行性。方法：分析１９９５年９月～２００１年２月经鼻－蝶窦内窥镜治疗的５０例病人的诊断、手术及预后等临床资料。结果：５０例患者中微腺瘤３例,局限于鞍内的大腺瘤１０例,向鞍上生长未突破蝶窦者７例,向蝶窦内下陷的大腺瘤３０例,其中巨大型肿瘤７例,均向上突破鞍膈向下进入蝶窦。病人术后视力视野均好转,内分泌功能异常得到改善,术后短暂性多尿者６例,术后短暂性脑脊液鼻漏者３例,均为肿瘤巨大者,均经保守治疗而治愈。术后均无鼻腔通气障碍、鼻腔粘连、鼻中隔穿孔等鼻腔并发症及血管损伤性等严重并发症。结论：内窥镜经鼻－蝶窦手术是一种微创外科技术,可完全适用于垂体腺瘤的治疗。     

经鼻内窥镜垂体腺瘤切除术

目的探讨鼻内窥镜在垂体腺瘤手术中的应用价值和适应证。方法开展了２４例经鼻内窥镜垂体腺瘤切除手术。２４例垂体腺瘤患者中２０例为经鼻蝶窦进路，４例为经鼻中隔蝶窦进路。结果２０例经鼻蝶窦进路瘤组织得到了完全切除，手术所需时间较经鼻中隔蝶窦进路显微外科手术明显缩短。４例经鼻中隔蝶窦进路中３例瘤组织完全切除，１例非分泌性腺瘤（Ⅴ期）患者因瘤组织侵犯鞍旁及海绵窦，仅行大部分切除。所有患者术后头痛、视力障碍和闭经泌乳等症状均有改善。１６例次术前血清泌乳素（ＰＲＬ）水平异常（２３．０～１２５．０μｇ／Ｌ，平均６４．９±４３．７μｇ／Ｌ）的患者，术后血清ＰＲＬ水平恢复正常。９例次术前血清生长激素（ＧＨ）水平异常（５０．０～７２．０μｇ／Ｌ，平均６２．１±１１．４μｇ／Ｌ）的患者，术后血清ＧＨ水平低于５．０μｇ／Ｌ。上述患者术后随访２～７２个月（平均１８±２１个月）无复发。术后均未见颅内出血、视神经损伤、脑脊液鼻漏、脑膜炎及垂体功能低下等并发症。结论经鼻内窥镜垂体腺瘤切除术是一个简便、安全、有价值的外科技术，只要正确地掌握好此类手术的适应证，可以获得满意的治疗效果。     

蝶窦鞍区非垂体源性占位病变的诊断

目的 提高蝶窦鞍区非垂体源性占位性病变的诊断水平。方法 总结分析２４例蝶窦鞍区非垂体源性占位性病变，其中良好１８例，包括蝶窦囊肿７例、颅咽管瘤６例、脊索瘤２例，鼻息肉伴鼻结杆菌感染侵犯蝶窦鞍区、蝶鞍神经鞘瘤、鞍内异位松果体瘤各１例。恶性肿瘤６例，分别为蝶窦神经内分泌肿瘤２例，腺样囊腺癌１例，蝶窦低分化癌１例，鼻咽癌侵犯区肺癌蝶窦转移各１例。从临床表现、体征、曩像学检查及诊断治疗上进行了分析、讨论。     

内窥镜下蝶窦和蝶鞍手术

目的 探讨内窥镜下蝶窦和蝶鞍区手术的体会。方法 内窥镜下治疗脑脊液蝶窦漏１例，蝶窦金属（子弹）异物３例，蝶窦囊肿５例，蝶窦霉菌病５例，蝶窦息肉１例，蝶筛窦腺癌１例；垂体腺瘤２３例（微腺瘤１７例，侵袭性腺瘤６例），颅咽管瘤２例。结果 蝶窦囊肿、息肉和霉菌病治愈；垂体微腺瘤和１例颅咽管瘤全切术；侵袭性腺瘤、１例颅咽管瘤和蝶筛窦腺癌部分切除，死亡１例（垂体腺瘤术中出血）；脑脊液鼻漏治愈；蝶窦异物２例取出     

内窥镜经鼻内蝶窦垂体腺瘤切除术

目的：探讨内窥镜经鼻－蝶窦入路切除垂体腺瘤,尤其是巨大垂体腺瘤的可行性。方法：分析1995年9月－2001年2月经鼻－蝶窦内窥治疗的50例病人的诊断、手术及预后等临床资料。结果：50例患者中微腺瘤3例,局限于鞍内的大腺瘤10例,向鞍上生长未突破蝶窦者7例,向蝶窦内下陷的大腺瘤30例,其中巨大型肿瘤7例,均向上突破鞍膈向下进入蝶窦。病人术后视力视野均好转,内分泌功能异常得到改善,术后短暂性多尿者6例,术后短暂性脑脊液鼻漏者3例,均为肿瘤巨大者,均经保守治疗而治愈。术后均无鼻腔通气障碍、鼻腔粘连、鼻中隔穿孔等鼻腔并发症及血管损伤性等严重并发症。结论:内窥镜经鼻－蝶窦手术是一种微创外科手术,可完全适用于垂体腺瘤的治疗。     

蝶窦鞍区非垂体源性占位性病变的诊断

目的提高蝶窦鞍区非垂体源性占位性病变的诊断水平。方法总结分析２４例蝶窦鞍区非垂体源性占位性病变，其中良性１８例，包括蝶窦囊肿７例、颅咽管瘤６例、脊索瘤２例，鼻息肉伴鼻硬结杆菌感染侵犯蝶窦鞍区、蝶鞍神经鞘瘤、鞍内异位松果体瘤各１例。恶性肿瘤６例，分别为蝶窦神经内分泌肿瘤２例，腺样囊腺癌１例，蝶窦低分化癌１例，鼻咽癌侵犯鞍区及肺癌蝶窦转移各１例。从临床表现、体征、影像学检查及诊断治疗上进行了分析、讨论。结果２４例临床表现中１８例有头痛，１７例出现眼部症状。２４例均经ＣＴ扫描发现蝶鞍区占位性病变并提示了病变范围。结论①良恶性病变均以头痛为第一常见症状，眼部症状为第二常见症状，掌握眼部症状与蝶鞍占位的关系对及早诊断意义重大；②影像学检查对此区域病变的发现和诊断起着重要作用；③内窥镜的应用及镜下穿刺活检亦对诊断十分有帮助。良性肿瘤以手术切除为主，恶性肿瘤手术＋放射治疗。     

鼻科学

008 蝶窦深度以及鼻、咽与垂体窝间距的测量杨琳李振华山东医学院学报(2):21,1983为满足临床垂体周围手术的需要和填补国人同类资料的不足,本文对55例(成人30例,儿童25例)头颈正中矢状切面标本进行了观察和测量。观察了蝶窦的发育状况,蝶窦的深度,测量了从鼻腔蝶窦口到垂体窝底的最短距离和从咽顶部至垂体窝底的最短距离,结果如下:     

鼻内镜下垂体腺瘤切除术——附28例报告

目的：探讨鼻内镜下垂体腺瘤手术的治疗经验。方法：鼻内镜下经鼻中隔-蝶窦、鼻内镜辅助经鼻中隔-蝶窦和经鼻腔-蝶窦三种入路手术行垂体腺瘤切除术，共28例。结果：Hardy-Wilson分级Ⅰ级者7例全切除；Ⅱ级者7例，5例全切除，2例次全切除；Ⅲ级者11例，5例全切除，5例次全切除，1例部分切除；Ⅳ级者3例，部分切除。严重并发症蛛网膜下腔出血1例，死亡1例。术后随访2个月～56个月，手术全切除17例中1例复发。结论：鼻内镜下垂体腺瘤手术克服了显微镜下不能观察蝶窦外侧壁重要血管和神经等结构的缺点，经鼻内镜垂体腺瘤切除术具有操作简单、到达蝶鞍比较容易、损伤小的优点，符合微创外科手术原则。     

鼻内窥镜下蝶窦及鞍区手术

目的 探讨鼻内窥镜下蝶窦及鞍区手术的临床效果。方法 内窥镜下经鼻腔入路治疗垂体腺瘤２例、蝶窦子弹异物２例、霉菌病２例和蝶窦囊肿１例。结果 蝶窦囊肿和霉菌病痊愈;蝶窦异物１例失败;垂体腺肿瘤患者视力恢复、脑脊液鼻漏治愈。结论 鼻空窥镜下蝶窦及鞍区手术,操作简单,安全有效,治疗鞍区病变有一定的价值。     

催乳素垂体腺瘤经蝶显微外科治疗

目的 探讨催乳素垂体腺瘤经蝶显微手术的治疗效果。方法 总结１１９例催乳素垂体腺瘤采取经蝶显微手术的治疗安全性与远期疗效。本组女１０７例，男１２例。年龄１３～５６（平均３６．７）岁。术前均经ＣＴ扫描中ＭＲＩ确诊，其中大腺瘤１５例（１２．６１％），微腺瘤１０４例（８７．４％）。手术采取经唇下－鼻中隔－蝶窦入路行肿瘤切除术。结果 术后并发症少，无死亡。１０３例（８６．６％）行随访观察，随访期６月～７．５     

原发于蝶窦外侧隐窝囊肿的诊断与鼻内镜手术治疗

目的　探讨原发于蝶窦外侧隐窝囊肿的临床特征及鼻内镜治疗的疗效。方法　回顾性分析我院2007～2015年间收治的9例原发于蝶窦外侧隐窝囊肿患者的临床资料及术后随访结果。其中7例患者以面颊部麻木感为主诉,2例患者进行性视力下降为主诉;头面部均无明显阳性体征。均于全麻内镜下经蝶窦入路行囊肿开窗引流术。结果　所有患者术中及术后均无并发症发生,术后症状均消失。随访6～24个月,所有患者的囊肿引流口均与蝶窦相通形成永久性引流口,无闭塞或复发。结论　①原发于蝶窦外侧隐窝囊肿的有其独有的症状及影像学特征,区别于一般的蝶窦囊肿;②鼻内镜下经蝶窦入路行囊肿开窗切除术是治疗原发于蝶窦外侧隐窝囊肿的微创、安全、有效术式。     

鼻窦CT及MRI检查在单侧良性蝶窦病变中的临床应用

目的 回顾分析单侧良性蝶窦病变在CT及MRI中的影像学表现,探讨在临床中的应用价值。 方法 分析21例单侧良性蝶窦病变且经鼻内镜手术及术后病理证实的住院患者的影像学特征。 结果 21例单侧良性蝶窦病变中,囊肿7例,CT表现为蝶窦内圆形或卵圆形较均匀软组织密度影,蝶窦腔膨胀性改变者可伴有骨质吸收变薄,MRI表现为长T1和长T2不规则球形信号影;真菌性病变8例,CT表现为蝶窦内不规则点片状钙化斑或云絮状密度增高影,呈毛玻璃样改变,MRI表现为蝶窦内混杂信号,炎症片状渗出呈高信号,真菌结节呈T₂WI低信号;脑脊液鼻漏3例,CT表现为蝶窦内单纯软组织密度影,MRI表现为脑脊液高信号影与鼻窦内高信号液体影之间有线状高信号影相连,其他组织(脑组织、鼻黏膜)呈低信号;内翻性乳头状瘤3例,CT表现为蝶窦内软组织密度影,密度欠均匀,MRI表现为肿物有不均匀强化,呈现条索样或不同程度“脑回征”。 结论 CT可以较好地显示病变周围的骨质改变,MRI能更清楚地显示病变侵袭范围,两者结合可为单侧良性蝶窦病变诊断及临床治疗提供更全面的影像信息。CT结合增强MRI分析比单纯依靠CT扫描更具鉴别诊断价值。     

孤立性蝶窦病变的临床诊断与微创手术

目的　探讨孤立性蝶窦病变的临床诊断及微创手术方法。方法　对收治的 2 8例孤立性蝶窦病变的临床资料进行回顾性分析并文献复习。结果　 2 8例病人术前均经CT或 /和MRI及鼻内镜确诊。术后病理检查证实为蝶窦炎症 6例 (其中伴后鼻孔息肉 4例 )、蝶窦真菌感染 7例、蝶窦黏膜下囊肿 1 0例、蝶窦黏液囊肿 4例(其中 2例侵犯颅底及眼眶、1例至鼻中隔 )、蝶窦内翻性乳头状瘤 1例。 2 8例全部治愈。结论　对临床上有不明原因的头痛、头晕、眼部症状、回缩涕血有必要结合影像学检查及鼻内镜检查 ,以便早期确诊。鼻内镜下鼻腔进路联合切割吸引器对蝶窦病变进行微创手术是治疗孤立性蝶窦病变的一个安全有效的手术方式。     

Inverted papilloma of the sphenoid sinus: presentation of three cases

INTRODUCTION: Inverted papilloma deriving originally from the sphenoid sinus is extremely rare. Three such cases are presented aiming to show the particularities and diagnostic clues of this clinical entity. CASE REPORTS: All three patients were male, and presented mainly with nasal symptoms. In all three cases imaging shows the sphenoid sinus was completely occupied by the tumor. Additionally the ethmoids and nasal cavities have been invaded in contiguity to the site of the initial appearance of the tumor. In particular one of the cases was of even more interest as a malignant transformation of the inverted papilloma of the sphenoid sinus was histologically observed. Endoscopic sinus surgery was the therapeutic approach chosen for all three cases, with very good results. Follow up 30 months after the operation has not revealed any signs of recurrence of the disease. CONCLUSION: Inverted papilloma of the sphenoid sinuses--and even more malignant transformation--although quite rare, may present occasionally. The ENT surgeon should be aware of this condition. Preoperative imaging with CT scan and MRI and the experience of the surgeon will dictate the appropriate surgical approach.     

孤立性蝶窦疾病的诊断及其鼻内镜手术治疗

目的：探讨孤立性蝶窦疾病的临床特点、影像学特征和鼻内镜手术的疗效。方法：38例孤立性蝶窦疾病患者,35例行鼻窦CT（其中5例同时行MRI）,3例行单纯鼻窦MRI,1例行脑池CT造影。所有患者均行鼻内镜下蝶窦开放术,其中有33例采用经鼻腔嗅裂径路,5例采用经前筛一后筛径路（即Messerklinger技术）。结果：术后随访6个月以上,34例病情完全控制,4例部分控制。术中和术后均未出现严重并发症。结论：孤立性蝶窦疾病临床症状不典型,无特异性,鼻部检查多无阳性体征,仅有以头痛为主诉的神经系统症状,早期常难以确诊。鼻窦CT和MRI是诊断孤立性蝶窦炎的最佳手段,而鼻内镜手术则是治疗该病的首选方法。     

Fungal mucoceles of the sphenoid sinus

OBJECTIVE: The purpose of this study was to demonstrate that fungal mucoceles of the sphenoid sinus do not necessarily require an external approach for eradication of disease. We report 6 cases of fungal mucoceles of the sphenoid sinus seen at UCLA Medical Center from 1980-1999, 4 of which were successfully treated with endoscopic intranasal sphenoidotomy and the other 2 through either a transseptal or transantral approach. STUDY DESIGN AND METHODS: Case series. The medical records of 6 patients with fungal mucoceles of the sphenoid sinus treated at UCLA Medical Center over a 20-year period (1980-1999) were retrospectively reviewed. RESULTS: Six patients diagnosed with fungal mucoceles of the sphenoid sinus were seen at UCLA Medical Center from 1980-1999. Endoscopic intranasal sphenoid sinusotomy was performed on 4 patients and a transseptal or transantral approach to the sphenoid sinus was used on the remaining 2 patients. No evidence of recurrent disease has been seen after up to 15 years of follow-up. CONCLUSIONS: When diagnosed early, functional endoscopic intranasal sphenoidotomy represents an effective mode of treatment for patients with fungal mucoceles of the sphenoid sinus, obviating the need for more aggressive surgical approaches.     

孤立性蝶窦疾病18例临床分析

目的：探讨孤立性蝶窦疾病的诊断及合理的治疗方法。方法：回顾性分析18例经鼻内镜手术治疗的孤立性蝶窦疾病患者的临床资料。结果：18例中，炎性疾病l5例(急性炎症2例，慢性炎症3例，囊肿8例，真菌病2例)，恶性肿瘤3例。经鼻内镜手术后随访3个月至半年，蝶窦前壁开窗通畅，窦腔各壁光滑，症状明显改善，无并发症发生。结论：头痛是孤立性蝶窦疾病的常见症状，另有视力损害、血性涕及其他脑神经麻痹症状，CT、MRI及鼻内镜检查为其诊断提供有力依据；鼻内镜手术治疗是一种安全、有效、简便的方法。     

孤立性蝶窦疾病的诊断和治疗

目的探讨孤立性蝶窦疾病的临床表现,提高首诊准确率,并寻求合适的治疗方法。方法22例术前均行CT或MRI和鼻内镜检查,术中取病变组织送病理明确诊断。结果经鼻内镜手术后随访5个月至两年半,22例症状明显好转,蝶窦前壁通畅,窦壁光滑。结论孤立性蝶窦疾病并非罕见,头痛是常见非特异性症状,可伴有视力下降等颅神经损害及血性涕等症状。鼻内镜手术是治疗本病的首选术式。     

Pneumatization of the sphenoid sinus in children evaluated by magnetic resonance imaging

Previous studies concerned with the normal development of the sphenoid sinus have reported that the onset of initial pneumatization varies from 6 months to 4 years of life, and that the pneumatization is completed by 12 to 14 years of age. This study was designed to evaluate the age-related development of the sphenoid sinus pneumatization in children using magnetic resonance (MR) imaging technique. MR images of the sphenoid sinus in 152 children, ages 2 months to 163 months, were retrospectively reviewed. The degree of pneumatization was classified into four grades as 0, 1, 2, and 3 in axial images, and into five grades as 0, 1, 2, 3, and 4 in sagittal images. The numbers of grades were age-matched in the studied children. The pneumatized sphenoid sinus was identifiable as early as 2 months of age on axial image, and 4 months on sagittal image. Pneumatized sphenoid sinuses were identified in 100% of the subjects studied at the age of 3 years on axial image, and 6 years on sagittal image. All the children over 9 years old showed pneumatization of grade 2 or more both on axial and sagittal images. The results of this study may indicate that the sphenoid sinus begins and completes pneumatization earlier than previously described.     

Isolated inverting papilloma of the sphenoid sinus

OBJECTIVES/HYPOTHESIS: Primary inverting papilloma of the sphenoid sinus is rare. We present a case of inverting papilloma with isolated involvement of the sphenoid sinus and discuss the incidence, clinical presentation, radiographic features, histological findings, and management of patients with this disease. STUDY DESIGN: Case report. METHODS: The medical records, films, and pathology slides of a patient with isolated inverting papilloma of the sphenoid sinus seen at University of California Los Angeles Medical Center were reviewed. The clinical presentation, radiographic features, histopathological findings, treatment, and outcome of the case were examined. RESULTS: A single case of inverting papilloma with isolated involvement of the sphenoid sinus is presented. Headache and diplopia were the presenting complaints, as is often seen with other isolated sphenoid sinus lesions. Endoscopic intranasal sphenoid sinusotomy was performed, and no evidence of recurrent disease has been seen after 6 months of follow-up. CONCLUSIONS: Isolated inverting papilloma of the sphenoid sinus is a rare phenomenon. In contrast to the vast majority of cases that present with nasal complaints (i.e., unilateral nasal obstruction, epistaxis) because of involvement of the lateral nasal wall, the clinical presentation of inverting papillomas confined to the sphenoid sinus is often nonspecific and insidious, with visual deficits being the predominant feature. Nevertheless, functional endoscopic intranasal sphenoidotomy remains an effective mode of treatment for patients with these lesions.