经单鼻孔蝶窦入路显微手术切除垂体腺瘤

目的探讨经单鼻孔蝶窦入路显微手术切除垂体腺瘤的手术方法。方法回顾性分析46例垂体腺瘤患者的临床资料,均采用经单鼻孔蝶窦入路显微手术切除肿瘤。术前行高分辨率CT鞍区薄层扫描及MRI检查,充分了解蝶窦的气化程度、蝶窦分隔和鞍底隆突的解剖学特点。结果44例术中依靠蝶窦相关解剖标志,准确定位蝶窦及鞍底,2例出现偏差。肿瘤全切33例,大部分切除9例,部分切除3例,1例因海绵间窦出血终止手术,无手术死亡。术后一过性尿崩症12例,予药物治疗3～7d后好转 脑脊液漏4例,2例保守治疗治愈,1例予腰大池置管引流后治愈,1例再次经蝶入路修补鞍底后治愈。46例平均随访8个月（3个月～2年）,3例复发。结论单鼻孔蝶窦入路显微手术切除垂体腺瘤是一种安全有效的微侵袭手术方法 熟悉相关解剖标志,准确定位是手术成功的关键。

Single-nostril Transsphenoidal Microsurgery for Pituitary Adenoma

Objective To discuss the microsurgical techniques for treating pituitary adenoma by single- nostril transsphenoidal approach. Methods The clinical data of 46 pituitary adenoma eases underwent sin- gle-nostril transsphenoidal microsurgery were reviewed. The gasification degree and the partition of sphenoid si- nus, and the anatomic features of prominentia on sellar floor were comprehended adequately by high resolution CT and MRI. Results According to the related anatomy landmarks, the sphenoid sinus and the sellar floor were precisely located in 44 cases and deviously located in 2 cases. Total resection was achieved in 33, subtotal resection in 9, and partial resection in 3. And another one case was terminated the operation because of inter- cavernous sinuses bleeding. No one died. Transient diabetes insipidus was found in 12 cases and was cured by drug treatment within 1 week after operation. Nasal cerebrospinal fluid leakage was observed in 4 eases, and were cured by expectant treatment in 2, lumbar cistern drainage in 1 and reoperation of repairing sellar floor via the transnasal-sphenoidal approach in I case. All eases were followed up for 3 months to 2 years （ mean 8 months） , 3 cases relapsed. Conclusions Single-nostril transsphenoidal microsurgery is a safe and effec- tive method for pituitary adenoma. Familiarity of the related anatomic landmarks of sphenoid sinus and precise location are the key points to successful operation.