“筷子技术”在鼻内镜经鼻入路手术中的应用

目的探讨"筷子技术"在鼻内镜经鼻入路手术中的安全性及有效性。方法回顾性分析2017年6月至2019年5月采用"筷子技术"进行鼻内镜经鼻入路手术切除的62例鞍区或鞍旁病变的临床资料。经鼻蝶入路43例,经鼻蝶扩大入路16例,经鼻经翼突入路1例,经鼻咽至齿状突入路1例,经鼻泪前隐窝入路1例。结果 62例中,垂体腺瘤46例,Rathke囊肿5例,颅咽管瘤4例,斜坡脑膜瘤2例,空泡蝶鞍1例,炎性肉芽肿1例,翼腭窝及海绵窦旁腺样囊性癌1例,颞下窝神经鞘瘤1例,脊髓空洞合并齿状突畸形1例;病灶全切除53例,次全切除9例。术后发生脑脊液鼻漏4例、垂体功能低下9例、电解质紊乱17例、尿崩症11例。术后随访2～22个月,平均(12±6.2)个月;随访期间均未见复发。结论在鼻内镜经鼻入路手术中,应用"筷子"技术可以满意完成经筛、经蝶、经翼突、经泪前隐窝等多种入路操作,有效缓解了传统经鼻手术时主刀与助手间的不契合问题,改良术中体验,提升手术效率。

Application of "chopsticks technique" in endoscopic endonasal approach surgery

Objective To explore the safety and effectiveness of "chopsticks technique" in the endoscopic endonasal approach surgery. Methods The clinical data of 62 patients with sellar or parasellar lesions who underwent endoscopic endonasal approach surgery assisted by "chopsticks technique" from June 2017 to May 2019 were analyzed retrospectively. The "chopstick technique" was performed that the surgeon held both endoscope and aspirator in left hand, which was like holding a pair of chopsticks, and held another surgical instrument to complete various procedures in right hand during the surgery. The surgeries performed on the basis of the location and size of lesions, including traditional endoscopic transnasal transsphenoidal approach in 43 patients, expanded endoscopic transnasal transsphenoidal in 16, transpterygoid in 1, endoscopic transnasopharyngeal for odontoid abrasion in 1 and endoscopic prelacrimal recess in 1. Results Of these 62 patients, 46 patients were pituitary adenomas, 5 were Rathke cysts, 4 were craniopharyngiomas, 2 were clonal meningioma, 1 was vacuolar sella, 1 was inflammatory granuloma, 1 was cystic carcinoma in the pterygopalatine fossa and paracavernous glands, 1 was schwannoma in the inferior temporal fossa, and 1 was syringomyelia associated with odontoid malformation. Total resection of lesions was achieved in 53 patients and subtotal in 9. Gamma knife radiotherapy was performed on 6 of 9 patients with subtotal resection of lesions one month after the surgery. Postoperative complications occurred in 41 patients, including cerebrospinal fluid rhinorrhea in 4, hypopituitarism in 9, electrolyte disorder in 17 and diabetes insipidus in 11. Conclusions During the endoscopic endonasal approach surgery, "chopsticks technique" can satisfactorily complete a variety of operations such as the operations via ethmoid approach, transsphenoidal approach, via pterygoid process approach and transepithelial crypts approach, which can significantly relieved the incompatibility between the surgeon and assistant during the traditional transnasal surgery, and improve the intraoperative experience and the efficiency of the operation