垂体腺瘤经蝶窦显微手术的临床研究

目的 探讨垂体腺瘤经蝶赛的手术途径和处理策略。方法 回顾性总结1992年-2004年68例垂体腺瘤经蝶手术的临床资料和疗效，术前行蝶窦断层X片、CT及MR检查，充分地了解蝶窦的气化程度和蝶窦的分隔。其中经唇下-鼻中隔-蝶窦入路7例；经鼻前庭-鼻中隔-蝶窦入路53例；经单鼻孔-蝶安直接入路8例。结果 全切除48例（70．6％），大部分切除18例（26．5％），部分切除2例（2．9％），无脑脊液漏和颅内感染发生；暂时性尿崩症2例，无永久性尿崩；未发生神经功能缺损，无手术死亡。随访13年内分泌症状56例中，28例恢复正常，20例改善，8例同术前。结论 经鼻前庭-鼻中隔-蝶窦入路显露理想，适应于各种类型垂体腺瘤；经单鼻孔-蝶窦直接入路省时、简捷，尤其适应于中小型垂体腺瘤；经唇下-鼻中隔-蝶窦入路显露理想，但有创伤大，耗时长等缺点。术前熟悉蝶窦的分隔是预防经蝶手术“迷途”的关键。

Clinical study on the microsurgery via the sphenoid sinus in the treatment of pituitary adenoma

Objective To explore the operative approachs and therapeutic strategies in the treatment of pituitary adenoma. Methods The clinical data and therapeutic results of 68 pituitary adenoma cases who underwent trans-sphenoidal microsurgery during 1992~2004 were analyzed retrospectively. Before the treatment, we comprehended adequately the gasification degree and the partition of sphenoid sinus by X-ray?CT and MR. The operative approaches are respectively sublabial-nasal septum-sphenoid sinus in 7 cases, nasal vestibule-nasal septum-sphenoid sinus in 53 cases and single nostril-sphenoid sinus in 8. Results Total removal of adenomas was achieved in 48 cases (70.6%), most removal in 18(26.5%), partial removal in 2(2.9%). There was no cerebrospinal fluid leak, intracranial infection, permanent diabetes insipidus, neurologic impairment and death, but temporary diabetes insipidus in 2 cases. In the 13-year follow-up, among 56 cases with endocrine symptoms, 28 got recovered, 20 improved and 8 unchanged. Conclusion The approach of nasal vestibule-nasal septum-sphenoid sinus offer a satisfied exposure of adenoma, suitable for all kinds of pituitary adenomas; single nostril-sphenoid sinus approach has an advantage of convenience and rapidness, especially for moderate or small adenomas; sublabial-nasal septum-sphenoid sinus can expose well the adenomas but lead to severe injury and spend too long time. The key of Trans-sphenoidal microsurgery is to be familiar with the gasification degree and partition of sphenoid sinus.