鼻内窥镜下鼻腔蝶窦径路垂体肿瘤切除术

目的 探讨在鼻内窥下经鼻腔蝶窦垂体肿瘤切除术的术式改进方法及麻醉方法。方法 用鼻窦内窥镜经鼻腔蝶窦入路切除垂体肿瘤４２例,其中局部麻醉加基础麻醉３７例,并作了如下改进：剥离梨骨翼及后鼻孔上缘区域的粘骨膜瓣和切除梨骨翼及蝶嘴,避免了损伤鼻中隔后动脉的可能,也增加手术操作的空间。结果 术中出血少,手术顺利,４２例均无并发症发生。术后随访６～３５个月,均有不同程度的症状改善。结论 用局部麻醉在鼻内窥镜下     

鼻内窥镜下鼻腔蝶窦径路垂体肿瘤切除术

目的　探讨在鼻内窥下经鼻腔蝶窦垂体肿瘤切除术的术式改进方法及麻醉方法。方法用鼻窦内窥镜经鼻腔蝶窦入路切除垂体肿瘤 42例 ,其中局部麻醉加基础麻醉 37例 ,并作了如下改进 :剥离梨骨翼及后鼻孔上缘区域的粘骨膜瓣和切除梨骨翼及蝶嘴 ,避免了损伤鼻中隔后动脉的可能 ,也增加手术操作的空间。结果　术中出血少 ,手术顺利 ,42例均无并发症发生。术后随访 6～ 35个月 ,均有不同程度的症状改善。结论　用局部麻醉在鼻内窥镜下经蝶窦行垂体肿瘤切除术是一种较简单、安全可行的手术及麻醉方式。     

鼻内镜单侧蝶窦入路显微手术切除垂体腺瘤(附17例报道)

目的探讨鼻内镜在经鼻腔一蝶窦垂体腺瘤显微手术中的作用。方法采用鼻内镜辅助下单侧蝶窦人路手术治疗垂体腺瘤17例。结果肿瘤全切15例,次全切2例,症状得到改善,术后无脑脊液鼻漏、鼻中隔穿孔及其它手术并发症。结论采用鼻内镜技术与显微外科技术相结合在经鼻腔一蝶窦垂体腺瘤切除术中具有优势互补的作用,有利于实现微创手术的目的。     

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。     

鼻内镜下经鼻腔-蝶窦入路切除垂体大腺瘤13例

目的：了解鼻内镜技术用于经蝶窦入路切除垂体大腺瘤的可行性。方法：对13例垂体大腺瘤患者采用鼻内镜下经鼻腔-蝶窦入路切除术式。结果：肿瘤全切除9例(69．2％)，大部切除3例(23．1％)，手术失败1例(7．7％)。术后1周内视力、视野明显改善10例(76．9％)，其中7例接近或完全恢复正常。除2例短暂脑脊液漏外，无其他严重并发症及死亡病例发生。结论：鼻内镜用于经鼻腔-蝶窦入路切除垂体大腺瘤可获得满意的临床效果，但应注意避免术中出血、解剖变异、鞍旁组织向鞍内膨出、复发性垂体大腺瘤及术后不适当的瘤腔处理对鼻内镜手术操作及疗效的影响。     

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。     

鼻内镜下蝶窦手术21例

目的 :探讨鼻内镜下治疗蝶窦良性病变的疗效和手术体会。方法 :2 1例患者在鼻内镜下进行鼻腔 蝶窦手术 ,其中全身麻醉 2例 ,局部麻醉辅以强化麻醉 19例。结果 :随访 3个月～ 4年。 2 0例痊愈 ,1例出现窦口闭锁 ,行再次手术开放 ,无一例出现严重并发症。结论 :局部麻醉鼻内镜下蝶窦手术具有视野清楚、损伤小、出血少、痛苦小等优点 ,是一种安全、有效的手术方式     

鼻内镜联合显微镜行蝶窦及经蝶鞍区微创手术

目的探讨经单侧鼻腔直接入路行蝶窦及经蝶鞍区微创手术的方法。方法鼻内镜下用Hardy′s撑开器外移中鼻甲,扩大鼻腔,直达并开放蝶窦前壁,联合显微镜切除病变。结果12例孤立性蝶窦炎术后窦口开放良好,症状消失。9例蝶窦囊肿、脑膜瘤一次手术切除。1例蝶窦骨瘤术后症状消失。1例外伤性失明视神经管减压,术后视力无恢复。33例垂体瘤中 18例行全切除术,12例行次全切除术,3例行大部分切除术,术后补充X刀治疗。56例术后随访6个月～3.5年,蝶窦炎、蝶窦囊肿、脑膜瘤、蝶窦骨瘤术后无复发,3例垂体腺瘤复发,无颅内及鼻腔并发症。结论鼻内镜联合显微镜经单侧鼻腔直接入路行蝶窦及经蝶鞍区手术,创伤小、时间短、出血少、并发症少、效果好,是目前较好的蝶窦及经蝶鞍区微创术式。     

经鼻内镜鼻中隔蝶窦径路垂体腺瘤切除术

目的：探讨经鼻内镜中隔一蝶安径路行垂体腺瘤印除术的方法。方法：对23例垂体腺瘤患者采用经鼻内镜中隔一蝶窦径路垂体腺瘤显微切除术。结果：23例垂体腺瘤均完全切除,手术时间短,术中平均出血量为50ml,术后平均住院日6d,术后无严重并发症。结论：与经蝶人路显微外科手术和鼻内镜下经蝶垂体腺瘤手术相比,经鼻内镜中隔一蝶窦径路垂体腺瘤切除术实现了经蝶人路显微外科手术和鼻内镜下经蝶垂体腺瘤手术的优势互补,手术创伤小,操作方便,切除彻底。具有良好的鼻内镜操作和显微手术技能,选择适当的适应证,可以达到理想的效果.     

内镜下经鼻蝶窦垂体瘤切除术患者鼻部相关生存质量研究

垂体瘤是以垂体前叶腺瘤为主的颅内肿瘤,手术治疗是最有效的治疗方法。随着内镜下经鼻蝶窦垂体瘤切除术的发展,经典的显微镜下鼻中隔-蝶窦垂体瘤术式逐渐受到限制;而内镜下经鼻蝶窦垂体瘤切除术因创伤小、并发症少而成为垂体瘤切除的最佳手段〔1-2〕。但经鼻内镜下切除垂体肿瘤时,可能对鼻腔的相关结构如上鼻甲、后组筛房以及蝶窦等进行处理〔1-2〕,这种创伤对于患者鼻部相关的生存质量产生何种程度的影响至今尚缺乏相关性研究。     

Approaches to sella turcica in endoscopic pituitary surgery

Recent advances in endoscopic sinus surgery suggested the potential for its surgical application to pituitary surgery. A number of institutions have reported the advantage of endoscope use in pituitary surgery, which is now widely accepted, but approaches to the sella vary in the literature. We retrospectively studied sella approaches in endoscopic pituitary surgery as rhinologists. Subjects included 6 cases of pituitary adenoma and 2 cases of Rathke's cleft cyst. A both-nostril transnasal transsphenoidal approach, our standard technique, was used in 6 cases. This approach consisted of elevation of mucoperiosteal flaps, resection of the vomer and sphenoid anterior wall, and opening of the sellar floor. Elevated mucoperiosteal flaps were used to close of the sella after tumor resection. All tumors were removed and no significant postoperative complications occurred. We found the both-nostril transnasal approach to be easy and time-saving and provided surgeon with a broad surgical field necessary to treat large tumors and accidental cases. Postoperative observation of the sella was easy for wide opening of the anterior wall of the sphenoid sinus. In our experience with reoperation, we quickly accessed the sella and easily removed tumors in the second operation. Our technique therefore has an advance in treatment of recurrence. The both-nostril transnasal approach involves the same procedures as median drainage of the sphenoid sinus, so our technique may have advantages in preventing mucocele of the sphenoid sinus as a late complication of transsphenoidal surgery. The transnasal transsphenoidal approach via both nostrils is preferable rhinologically.     

Comparison of techniques for transsphenoidal pituitary surgery

BACKGROUND: The aim of this study was to compare three different techniques for transsphenoidal pituitary surgery: (1) sublabial transseptal approach with microscopic resection, (2) transnasal transseptal approach with endoscopic resection, and (3) endoscopic approach with endoscopic resection. METHODS: We performed a retrospective review of 50 pituitary surgeries performed by the same neurosurgeon. Demographic, radiographic, and clinical data were collected. RESULTS: Fifteen patients underwent sublabial approach with microscopic tumor resection, 21 patients underwent the transnasal approach with endoscopic resection, and 14 patients underwent the completely endoscopic technique. There were a total of 20 complications in the sublabial group, 13 transnasal complications, and 6 endoscopic complications. Cerebrospinal fluid leak incidence was 53% in the sublabial approaches, 47% transnasal, and 28% in the endoscopic patients. Diabetes insipidus was encountered in 33% of sublabial approaches, 5% of transnasal approaches, and 7% of endoscopic approaches. Lumbar drains were required in 40% of sublabial approaches, 38% of transnasal approaches, and 7% of endoscopic approaches. Nasal packing was used in 100% of sublabial and transnasal approaches and 0% of endoscopic approaches. Mean recurrence rate and follow-up was sublabial in 6.6% (50 months), transnasal in 9.5% (11 months), and endoscopic in 0% (7 months). Average hospital stay for sublabial approaches, transnasal approaches, and endoscopic approaches was 8.3, 6.2, and 3.4 days, respectively (p < 0.05). CONCLUSION: Transsphenoidal pituitary surgery has evolved over the past several decades, because advances in technology have been the catalyst for minimally invasive surgeries. Less invasive approaches, such as the transnasal approach with endoscopic resection of tumor and the completely endoscopic .technique have less morbidity and a shorter hospital stay than traditional sublabial approaches. Continued follow-up is needed to confirm long-term benefits and similar recurrence rates.     

经鼻内窥镜垂体腺瘤切除术

目的 探讨鼻内窥镜在垂体瘤手术中的应用价值和适应证。方法开展了２４例经鼻内镜 体腺瘤切除手术。２４例垂体腺回味各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例非分泌性腺瘤患者因瘤组织侵犯鞍旁及海绵窦，仅行大部分切除。所有秫后能、视力障碍和闭经泌乳等症状均有     

经鼻内镜治疗累及蝶窦的中颅底占位性病变

目的：探讨累及蝶窦的中颅底占位性病变的诊断治疗方法。方法：对18例累及蝶窦的中颅底硬膜外占位病变患者施行经鼻内镜手术。结果：1例原发性空蝶鞍误诊为蝶窦囊肿,1例骨纤维异常增殖、1例脑膜瘤误诊为真菌性蝶窦炎,误诊率为16.7%。17例全部切除病变,1例大部分切除肿瘤。术中出血量100～2 500 ml。15例治愈,无并发症;1例并发细菌性脑膜炎治愈;1例双眼失明;1例因肺栓塞死亡。结论：经鼻内镜治疗蝶窦和累及蝶窦的中颅底硬膜外良性占位性病变可行。术前明确诊断、术中准确定位和仔细操作是手术成功的重要保证。     

Transphenoidal endoscopic approaches for pituitary adenomas: a critical review of our experience

BackgroundThe surgical approach to the pituitary fossae has evolved from transcranial to sublabial and transseptal microscopic ones, up to the current transsphenoidal endoscopic approach.ObjectivesTo present our experience in the transnasal transsphenoidal approach for pituitary adenomas and the modifications introduced to improve tumoral resection and to lower iatrogenia.Material and methodsOver nine years, we operated on 37 patients with pituitary adenomas using the transsphenoidal endoscopic approach. We utilised optical lens of 0° (approach) and 30° (adenoma resection), optic navigator, surgical instruments for nasal endoscopic and pituitary surgery. During the neurosurgical step, the endoscope was fixed by an articulated arm. We acceded to the pituitary fossae by a bilateral sphenoidotomy.ResultsSphenoid pneumatisation was sufficient in all the patients. The more common postoperative complications were diabetes insipidus and endocrinology deficiencies. Postoperative rhinoliquorrhea affected only one patient. No alterations of nasal fossae were observed. Mean patient hospitalisation was five days.ConclusionsTranssphenoidal endoscopic approach guided by navigator gives significant advantages: Shorter operating time and fewer complications, greater safety and preservation of the nasal passages. Resecting the sphenoidal rostrum and a fragment of adjacent nasal septum improves surgical instrument management into the pituitary fossae and therefore adenoma resection. Endoscope fixation stabilises the vision and allows the second surgeon to help more effectively.     

鼻内镜下经鼻前颅底手术的探讨

目的：探讨经鼻内镜行前颅底手术的可行性及适应证范围。方法：收集并分析我科近年来在鼻内镜下治疗的前颅底疾病6例，包括脑膜脑膨出3例，脑脊液鼻漏2例，左球后肿瘤1例。6例均在全身麻醉下手术。结果：6例手术均一次性成功，无并发症出现。结论：在鼻内镜下行部分鼻前颅底手术具有创伤小、术后恢复快、并发症少等优点，但手术适应证应该严格掌握，术者必须具备熟练的解剖学知识、手术技巧和经验，必须配备先进的手术设备。     

Integración de la cirugía endoscópica en una unidad de base de cráneo: experiencia en los primeros 72 casos

IntroductionA multidisciplinary team is essential to develop and expand the indications in endonasal endoscopic skull base surgery.The aim of this study was to present our experience in a group of patients with skull base lesions treated using endonasal endoscopic approach.MethodsFrom January 2008 to January 2012, 72 patients with skull base involvement were diagnosed and treated in our centre.ResultsThe mean patient age was 53 years. The different pathologies included 36 pituitary adenomas, 10 cerebrospinal fluid leaks and 5 inverted papillomas as the most frequent pathologies. We performed a transsphenoidal transellar approach in 45 cases, a transmaxillary transpterygoid approach in 4 cases and a transnasal expanded approach in 6 cases. We performed an ethmoidal/sphenoidal approach in 12 patients and a Draf IIb/III procedure in four cases. Total resection was achieved in 61% of patients with pituitary adenomas, subtotal in 22% and partial in 17%. Successful repair was achieved in 86% of CSF leaks. No recurrences were observed in patients with inverted papilloma. Complications were observed in 21 patients (29%), 6 being major complications.ConclusionsOur centre stresses the importance of multidisciplinary collaboration in endoscopic endonasal skull base surgery.     

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 2 3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 ,失败 1例。结论　经鼻内窥镜蝶窦和蝶鞍手术定位准确 ,操作简单 ,安全有效 ,但有一定的适应证和并发症 ,须严格掌握和选择。