经蝶垂体腺瘤切除术的单侧鼻内切口及鞍底修复的改良

目的　探讨经蝶垂体腺瘤手术有关切口、鞍底修复等改良方法的优越性。方法　对 71例经蝶垂体腺瘤 (包括微腺瘤 10例 ,鞍内大腺瘤 2 6例 ,向鞍上扩展的大腺瘤 19例 ,侵及海绵窦并向鞍上扩展的大腺瘤 11例 ,复发性垂体腺瘤 5例 )手术采用单侧鼻内粘膜切口 ,49例肿瘤残腔及鞍底修复皆简化为仅用Tachocomb粘贴 ,骨性鼻中隔回复两侧粘膜之间原位。结果　本组肿瘤全切除 5 6例 ,次全切除 15例。视力下降者术后视力皆在短期内获得明显改善 ,无 1例并发脑膜炎、鼻中隔穿孔。 49例鞍底修复采用Tachocomb者 ,无 1例发生术后脑脊液漏。术后随访 2个月至 4年 ,5例肿瘤复发再次手术 ,66例生活自理 ,40例恢复原工作。结论　这些手术方法的改良简化并方便了手术 ,减少了损伤 ,防止了术后脑脊液漏、鼻中隔穿孔等并发症

Endonasal incision and modified repairation of sella floor in transsphenoidl pituitary surgery

Objective To study the advantage of modified methods regarding incision and repairation of sella floor in transsphenoidal approach for pituitury tumor removal.Method The transsphenoidal approach with unilateral incision of endonasal mucosa was performed for resecting pituitary tumor in 71 patients. Tachocombs were used for repairation of the sella floor in 49 cases. Results Of all 71 patiants, total resection of the tumor was performed in 56 and subtotal resection in 15. No patient was complicated by postoperative meningitis and rhinosetal perforation. Of the 49 cases with repairation of sella floor by Tachocombs, there was no case of postoperative CSF leakage.Conclusions Endonasal incision and modified repairation may simplify operative procedure, reduced damage and prevent postoperative complications of CSF leakage and rhinoseptal perforation.