经双鼻孔入路内镜下垂体腺瘤切除术

目的探讨经双鼻孔入路内镜下切除垂体腺瘤的方法、疗效、手术适应证和并发症。方法回顾性分析25例神经内镜下经双鼻孔入路垂体腺瘤切除术病人的手术经验。微腺瘤5例,大腺瘤20例,其中侵犯海绵窦5例。结果微腺瘤全切除5例;大腺瘤全切除13例,近全切除4例,大部切除3例;5例侵犯海绵窦的腺瘤中,近全切除3例,大部分切除2例。术后并发尿崩症6例,垂体前叶功能低下2例。结论经双鼻孔入路内镜下切除垂体腺瘤能够减少严重并发症,缩短手术时间,尤其适合治疗甲介型蝶窦、巨大和质地硬韧、鼻腔入路狭窄的垂体腺瘤及术中出血多的微腺瘤。

Endoscopic pituitary adenoma surgery via a double nostril approach

Objective To investigate the technique,effect,indications and complications of endoscopic resection for pituitary adenoma via double-nostril approach.Methods The surgical experience with pituitary adenoma in 25 patients was analyzed retrospectively.Five patients had microadenoma and 20 macroadenoma,including 5 invading the cavernous sinus.Results Total resection of the microadenoma was achieved in 5 cases.Total resection of macroadenoma was achieved in 13,subtotal resection in 4,partial resection in 3.In 5 with cavernous sinus invasion,subtotal resection was achieved in 3 and partial resection in 2.Six patients suffered from diabetes insipidus and 2 anterior pituitary hypofunction after operation.Conclusions Pituitary adenoma resection by double-nostril endoscopic approach can decrease serious complications and shorten surgical time.The approach is especially suitable for conchoidal sphenoidal sinus,giant and hard adenomas with narrow nasal space and microadenomas with severe bleeding intraoperatively.