内镜经鼻蝶入路手术治疗大型垂体腺瘤

背景与目的：对于大型垂体腺瘤,传统的开颅和经蝶入路手术均难以全切,本文探讨内镜经鼻蝶入路切除大型垂体腺瘤的手术技术。方法：回顾性分析2000年9月-2005年12月间治疗的大型垂体腺瘤患者39例,术前均行头CT、MRI及内分泌学检查,手术采用内镜经鼻蝶入路肿瘤切除术。结果：本组患者无手术死亡,肿瘤全切除23例（60．0％）,近全切除14例（35．9％）,部分切除2例（5．1％）。术后随访6—24个月,症状和内分泌学指标均有所改善,肿瘤复发2例。结论：内镜经鼻蝶手术是治疗大型垂体腺瘤微创、安全的方法。     

神经内镜下再次经蝶窦手术治疗复发性垂体腺瘤

背景与目的：近年来随着内镜光学技术的发展和五官科医生在鼻窦手术中广泛使用内镜．内镜在经蝶窦垂体腺瘤外科中的应用逐渐被熟知。本研究主要探讨神经内镜下再次经蝶窦手术治疗复发垂体腺瘤的安全性及临床疗效。方法：对12例经蝶手术后复发的垂体瘤患者进行了内镜下再次经蝶切除术。观察其安全性、肿瘤切除情况及手术并发症等。结果：内镜下全切除8例。次全切除2例。大部分切除2例。本组术后无死亡及严重并发症,常见并发症为一过性尿崩症、电解质紊乱和脑脊液鼻漏,术后83％（10／12）患者临床症状明显改善．12例随访6个月至5年,疗效满意。结论：神经内镜下再次经蝶窦手术治疗复发性垂体腺瘤是安全有效的．而熟练的内镜技术和可靠的颅底重建是手术成功的关键。     

经鼻内镜鼻中隔蝶窦径路垂体腺瘤切除术的临床观察

目的 探讨经鼻内镜鼻中隔蝶窦径路行垂体腺瘤切除术的方法.方法 对27例垂体腺瘤行经鼻内镜鼻中隔蝶窦径路显微切除术.结果 27例垂体腺瘤均完全切除,手术时间短,术中平均出血量为50 mL,术后平均住院时间6 d,术后无严重并发症发生.结论 经鼻内镜鼻中隔蝶窦径路垂体腺瘤切除术实现了经蝶入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,且手术创伤小,操作方便,肿瘤切除彻底.     

神经导航辅助下经鼻蝶入路行垂体腺瘤切除术

背景与目的：单鼻孔经蝶入路垂体腺癌切除术已较为成熟，本文探讨神经导航系统在单鼻孔经蝶入路垂体腺瘤切除术中的应用。方法：在46例垂体腺瘤患者中，应用导航系统辅助手术，术前对患者行核磁共振连续薄层扫描，将影像信息导入神经导航系统进行解剖学三维重建，术中对肿瘤及周围重要结构实时定位，判断肿瘤的切除范围。结果：本组23例患者中肿瘤全切除38例，次全切除8例。术后30例内分泌学指标恢复正常，32例头痛好转，20例视力好转，16例出现一过性尿崩症，均无出血、视力、视野障碍、脑脊液漏、颅内感染等并发症。结论：神经导航系统在手术中定位准确，可以实时准确的指示术区的有关解剖结构．并引导手术操作，有效地减少了创伤，提高了手术疗效。     

经鼻中隔中后段垂体肿瘤切除术12例报告

背景与目的：垂体瘤手术经鼻入路较经口入路有较多优点，本文探讨直接经单侧鼻腔蝶窦入路显微手术切除垂体瘤方法。方法：12例垂体肿瘤经CT扫描或MRI明确手术适应证后，手术均采取经单侧鼻腔蝶窦入路显微手术切除肿瘤。结果：全切10例，次全切除1例，部分切除1例。视力、视野恢复7例，并发症主要有尿崩症2例和脑脊液漏1例，无鼻梁塌陷、上门齿麻木及鼻中隔穿孔等并发症，无手术死亡。结论：单侧鼻腔经蝶入路垂体瘤切除术具有鼻腔结构损伤小，切除肿瘤彻底，术后并发症少等优点。     

经蝶手术治疗垂体生长激素腺瘤54例

目的探讨经蝶显微外科手术治疗垂体生长激素腺瘤的长期疗效和处理策略。方法回顾性分析54例经蝶入路显微手术治疗的垂体生长激素腺瘤患者的临床资料和长期随访结果。结果54例患者中,30例经口鼻蝶入路,24例经鼻蝶入路,全切除38例,次全切除11例,大部分或部分切除5例。手术并发症多为一过性,死亡1例（1．85％）,术后随访（随访期平均26．5个月）视力视野改善率为95％,生长激素水平大部分正常或不同程度下降。结论经蝶入路显微手术是垂体生长激素腺瘤的首选治疗方法,术前生长激素水平、肿瘤大小以及术中切除程度是影响长期疗效的重要因素。     

经蝶手术治疗垂体生长激素腺瘤54例

目的 探讨经蝶显微外科手术治疗垂体生长激素腺瘤的长期疗效和处理策略.方法 回顾性分析54例经蝶入路显微手术治疗的垂体生长激素腺瘤患者的II缶床资料和长期随访结果.结果 54例患者中,30例经口鼻蝶入路,24例经鼻蝶入路,全切除38例,次全切除11例.大部分或部分切除5例.手术并发症多为一过性,死亡1例(1.85%),术后随访(随访期平均26.5个月)视力视野改善率为95%,生长激素水平大部分正常或不同程度下降.结论 经蝶入路显微手术是垂体生长激素腺瘤的首选治疗方法,术前生长激素水平、肿瘤大小以及术中切除程度是影响长期疗效的重要因素.     

经蝶手术治疗垂体生长激素腺瘤54例

目的 探讨经蝶显微外科手术治疗垂体生长激素腺瘤的长期疗效和处理策略.方法 回顾性分析54例经蝶入路显微手术治疗的垂体生长激素腺瘤患者的II缶床资料和长期随访结果.结果 54例患者中,30例经口鼻蝶入路,24例经鼻蝶入路,全切除38例,次全切除11例.大部分或部分切除5例.手术并发症多为一过性,死亡1例(1.85%),术后随访(随访期平均26.5个月)视力视野改善率为95%,生长激素水平大部分正常或不同程度下降.结论 经蝶入路显微手术是垂体生长激素腺瘤的首选治疗方法,术前生长激素水平、肿瘤大小以及术中切除程度是影响长期疗效的重要因素.     

经蝶手术治疗垂体生长激素腺瘤54例

目的 探讨经蝶显微外科手术治疗垂体生长激素腺瘤的长期疗效和处理策略.方法 回顾性分析54例经蝶入路显微手术治疗的垂体生长激素腺瘤患者的II缶床资料和长期随访结果.结果 54例患者中,30例经口鼻蝶入路,24例经鼻蝶入路,全切除38例,次全切除11例.大部分或部分切除5例.手术并发症多为一过性,死亡1例(1.85%),术后随访(随访期平均26.5个月)视力视野改善率为95%,生长激素水平大部分正常或不同程度下降.结论 经蝶入路显微手术是垂体生长激素腺瘤的首选治疗方法,术前生长激素水平、肿瘤大小以及术中切除程度是影响长期疗效的重要因素.     

经蝶手术治疗垂体生长激素腺瘤54例

目的 探讨经蝶显微外科手术治疗垂体生长激素腺瘤的长期疗效和处理策略.方法 回顾性分析54例经蝶入路显微手术治疗的垂体生长激素腺瘤患者的II缶床资料和长期随访结果.结果 54例患者中,30例经口鼻蝶入路,24例经鼻蝶入路,全切除38例,次全切除11例.大部分或部分切除5例.手术并发症多为一过性,死亡1例(1.85%),术后随访(随访期平均26.5个月)视力视野改善率为95%,生长激素水平大部分正常或不同程度下降.结论 经蝶入路显微手术是垂体生长激素腺瘤的首选治疗方法,术前生长激素水平、肿瘤大小以及术中切除程度是影响长期疗效的重要因素.     

单鼻孔直接经蝶窦入路显微手术治疗垂体腺瘤

目的:探讨经单鼻孔蝶窦入路显微手术治疗垂体腺瘤的经验与方法。方法:回顾总结显微镜下单鼻孔经蝶窦入路切除46例垂体腺瘤,观察手术效果和并发症。具体手术方法是:将鼻窥器缓慢插入右鼻孔向上经中鼻甲直至蝶窦前壁,横行切开鼻中隔黏膜约1.5cm,保持窥器尖呈闭合状态向对侧偏移,使鼻中隔骨折移位。然后将窥器张开,此时在显微镜下即可见中线骨性隆起结构蝶嵴及两侧蝶窦开口。以蝶嵴及两侧蝶窦开口为标志,凿除蝶窦前壁约1.0~1.5cm,显露蝶窦腔,咬除蝶窦分隔,剥离电凝蝶窦黏膜,显露凸形鞍底,凿开并咬成1.2～1.5cm骨窗既见硬脑膜,电凝硬膜后穿刺,证实肿瘤后“十”字切开,显露肿瘤并予钳取和刮除。通常肿瘤切净后可见鞍隔塌陷,彻底止血,冲洗术腔,放入明胶海绵填塞。结果:手术过程顺利,肿瘤全切除34例,次全切除12例,无死亡及病残发生,激素水平均有明显改善,17例出现一过性尿崩症,5 例出现电解质紊乱,术后无脑脊液鼻漏发生。结论:不断改进的单鼻孔经蝶窦入路具有入路简捷、操作方便、安全高效的优点。      

Microsurgical resection of pituitary adenoma via single-nostril transsphenoidal approach

OBJECTIVE To explore the methods and experience of the single-nostril transsphenoidal approach for treating pituitary adenomas. METHODS We retrospectively analyzed 46 patients who had pituitary tumors and received surgery via the singlenostril transsphenoidal approach and observed the effects and complications of surgery. The specific surgical methods are： a nasal speculum is inserted slowly through the right nostril towards the anterior wall of the sphenoid sinus. A 1.5 cm incision is made into the nasal mucosa in the right nasal cavity at the level of the middle nasal turbinate. By fracturing the bony septum, a space is formed between the bilateral nasal mucosa and the bony septum of the sphenoid sinus. Then, the inside of the sphenoid sinus is exposed. The remaining part of the bony septum, the anterior sphenoid sinus wall, and the sphenoid mucosa are gradually removed. The anterior sphenoidotomy is less than 1.5 cm wide. After confirming the tumor by dural puncture, a cross incision of the dura is made, and the tumor is slowly removed by curette. The sella is usually collapsed and visible after the total tumor removal. When the tumor is resected satisfactorily, gelatin sponges are placed into the operative cavity to stop bleeding. RESULTS Postoperative MRI scans revealed that among the 46 cases, total resection of the tumor was achieved in 34 cases and subtotal in 12. No deaths or disability occurred, and the hormone levels of almost all patients improved. Signs of diabetes insipidus occurred in 17, electrolyte disturbances in 5, and there were no reports of postoperative cerebrospinal fluid rhinorrhea. CONCLUSION The direct single nostril transsphenoidal approach of continuous improvement has the advantages of a convenient approach, simplified operation, safety and high efficiency.     

经蝶内窥镜辅助下切除大型垂体腺瘤42例

[目的]探讨绎蝶内窥镜辅助下切除大型垂体腺瘤的手术方法、手术技巧及其优点。[方法]经内窥镜控制下经蝶手术入路手术治疗垂体榴患者42例。[结果]肿增全切36例．次全切6例．手术效果良好。[结论]经蝶内窥镜辅助下切除大型垂体腺瘤具有微创、照明良好、视野开阔等优点，是垂体瘤手术治疗的发展方向。     

经单鼻孔蝶窦入路切除垂体瘤：神经内镜和显微镜下比较研究

目的探讨显微镜和神经内镜下经单鼻孔蝶窦入路切除垂体瘤的临床应用和优缺点。方法对24例经CT扫描和MRI检查确诊为垂体瘤的患者在显微镜或神经内镜下经单鼻孔蝶窦入路直视下予以切除。结果显微镜组：10例全切除,2例大部分切除;内镜组：11例全切除,1例大部分切除。两组患者术后症状均有不同程度的改善,无严重并发症发生。结论内镜经鼻蝶垂体瘤手术中具有良好的深部照明及全景化的视野等优点,较显微镜下经单蝶入路切除垂体瘤的过程中更微创,提高了肿瘤的全切率,但两种术式都应该熟练掌握,根据不同的患者灵活地选择术式。     

Microsurgical Resection of Pituitary Adenoma via Single-Nostril Transsphenoidal Approach

OBJECTIVE To explore the methods and experience of the single-nostril transsphenoidal approach for treating pituitary adenomas.METHODS We retrospectively analyzed 46 patients who had pituitary tumors and received surgery via the single-nostril transsphenoidal approach and observed the effects and complications of surgery. The specific surgical methods are: a nasal speculum is inserted slowly through the right nostril towards the anterior wall of the sphenoid sinus. A 1.5 cm incision is made into the nasal mucosa in the right nasal cavity at the level of the middle nasal turbinate. By fracturing the bony septum, a space is formed between the bilateral nasal mucosa and the bony septum of the sphenoid sinus. Then, the inside of the sphenoid sinus is exposed. The remaining part of the bony septum, the anterior sphenoid sinus wall, and the sphenoid mucosa are gradually removed. The anterior sphenoidotomy is less than 1.5 cm wide. After confirming the tumor by dural puncture, a cross incision of the dura is made, and the tumor is slowly removed by curette. The sella is usually collapsed and visible after the total tumor removal. When the tumor is resected satisfactorily, gelatin sponges are placed into the operative cavity to stop bleeding.RESULTS Postoperative MRI scans revealed that among the 46 cases, total resection of the tumor was achieved in 34 cases and subtotal in 12. No deaths or disability occurred, and the hormone levels of almost all patients improved. Signs of diabetes insipidus occurred in 17, electrolyte disturbances in 5, and there were no reports of postoperative cerebrospinal fluid rhinorrhea. CONCLUSION The direct single nostril transsphenoidal approach of continuous improvement has the advantages of a convenient approach, simplified operation, safety and high efficiency.     

应用神经导航辅助技术在内镜下切除伴有甲介、鞍前型蝶窦的垂体腺瘤

背景与目的：多数学者认为伴有甲介、鞍前型蝶窦的垂体腺瘤不适合内镜下切除．但应用神经导航辅助技术可以克服其在内镜下手术的缺陷。本文着重探讨应用神经导航辅助技术在内镜下切除伴有甲介、鞍前型蝶蜜的垂体腺瘤。方法：回顾性分析我院自2004年10月至2008年10月应用神经导航技术对伴有甲介、鞍前型蝶窦变异的垂体瘤进行内镜下单鼻孔手术21例。其中生长激素腺瘤4例．高泌乳素腺瘤6例,促肾上腺皮质激素腺瘤7例,无功能性腺瘤4例。蝶窦冠状CT及蝶窦X线平片提示蝶窦形态,甲介型9例。鞍前型12例。术前行头部CT、MRI扫描,术中神经导航定位,在内镜下经单鼻孔切除肿瘤。结果：术后随访6．24个月,术前症状（视力受损、尿崩症）均在术后消失,血液、内分泌指标均在正常范围内。术后随访1年以上的病例（17例）复查MRI均提示未见肿瘤残留或复发。术后所有病例均未出现颅内出血、视力、视野障碍、尿崩、脑脊液漏、颅内感染等并发症。结论：对于伴有甲介、鞍前型蝶窦变异的垂体瘤手术．应用神经导航辅助内镜能确保术中定位准确,术野大且直观。有利于切除肿瘤．并保护周围重要结构．     

经单鼻孔蝶窦入路显微手术切除垂体腺瘤126例分析

目的:探讨经单鼻孔-蝶窦入路显微手术切除垂体腺瘤的临床意义。方法:对126例垂体腺瘤病人采用经单鼻孔-蝶窦入路显微手术切除。结果:全切除89例,次全切31例,部分切除6例,病人视力症状及内分泌功能术后均有改善。术后尿崩症18例、脑脊液漏13例、术腔血肿3例,经再次手术治疗均治愈。结论:经单鼻孔-蝶窦入路切除垂体腺瘤具有微创、安全、简便等优点,是大部分垂体腺瘤的首选手术方式。     

Transsphenoidal and Transcranial Surgery for Pituitary Adenomas

This paper reviews the progress made over the first century of pituitary surgery. The goals of surgery for pituitary tumors are to eliminate tumor mass effect and perform as complete a removal as possible, retain pituitary function, and normalize any hormonal hypersecretion. Since the initial transsphenoidal approach performed in Austria by Schloffer, the transsphenoidal approach has become the preferred surgical approach to most pituitary tumors. The history and development of the transsphenoidal approach to the sella is discussed, as are the contemporary techniques of microscopic and endoscopic pituitary surgery. The continued evolution of the variations and extension of the transsphenoidal approach to other lesions are reviewed. The indications and use of a transcranial approach to remove pituitary tumors are discussed. More recently, stereotactic radiosurgery (SRS) has become an important adjuvant management technique in the management of difficult pituitary adenomas, especially with cavernous sinus invasion.