内窥镜辅助下经单鼻腔蝶窦入路切除垂体腺瘤

目的　探讨局部麻醉下利用内窥镜辅助 ,经单鼻腔蝶窦入路切除垂体腺瘤的可行性、优缺点 ,适应证及注意事项。方法　采用MRI明确诊断 ,使用局部麻醉内窥镜电视监测下经单鼻腔蝶窦入路进行垂体腺瘤切除。结果　 30例病人中 2 5例肿瘤全切除 ,5例次全切除。术后 2～ 4小时病人即可下床活动 ,进食。术后平均 4天出院 ,无死亡、无感染。术后脑脊液鼻漏 1例 ,再次经鼻蝶入路修补后痊愈。随访 6～ 4 8个月 ,视力恢复到 1.0以上10例 ,内分泌功能正常 15例 ,月经恢复正常 10例。结论　内窥镜辅助下经单鼻腔切除垂体瘤使用局部麻醉是安全可行的 ,手术对病人的损伤和影响可以达到最低程度

Endoscopic pituitary tumor surgery by transmononasal sphenoid sinus approach used local anaesthesia

Objective To discuss the possibility, advantage, disadvantage and indication of endoscopic removal of pituitary adenoma by the transnasal sphenoid sinus approcch used local aneasthesia. Methods All 30 patients were determined by means of MRI or CT and secretory level test. Two patients were GH secreting adenoma, fifteen were prolactionma, three were GH and RL secreting adenoma mixed, ten were nonsecretory pituitary tumor. They were treatmened by transmonosal sphenoid sinus surgery under endoscope supervision used local anaethesia. Results At surgery, complete removal of tumor was achieved in 25 patients and subtotal removal was performed in the remaining five patients. After 2-4 hours postoperatively the patients get up and eat. Four days after operation patients were dischanged from hospital. There were no infection and dead with the follow-up 48 monthers, (mean follow-up period 29 mon).Five cases' vision recovered to more than 1.0,fifteen cases' secretory level rehabilitated, ten cases' menses rehabilitated. Conclusion Surgery for pituitary adenoma by transmononasal sphenoid sinus approach under endoscope supervision used local ananethesia is safe and possible. Operative injury and influence can be reduced to the lowest.