经单鼻孔-蝶窦入路切除垂体腺瘤(附27例报告)

目的 总结经单鼻孔-蝶窦入路切除垂体腺瘤的治疗体会。方法 对27例病人采用经单鼻孔-蝶窦入路进行垂体腺瘤切除术。结果 24例全切除，1例大部切除，2例部分切除。1例术中造成眶内侧壁-视神经管骨折，视神经损伤，导致患侧视力严重减退；2例嗅觉丧失；7例术后出现短期尿崩，合并不同程度的水、电解质紊乱，经临床治疗后缓解。结论 肿瘤向鞍上扩展较大或质地较硬时应慎选经蝶入路；迅速准确地将鼻镜安放于蝶窦前壁的最佳位置，是减少手术创伤，缩短手术时间的关键步骤；明胶海绵加生物胶可满意修复鞍底。术后应及时纠正低钠、低氯血症。

Mononostril-transsphenoidal operation for pituitary adenoma: report of 27 cases

Objective To summarize the initial experience of mononostril-transsphenoidal operation for pituitary adenoma. Methods 27 patients with pituitary adenoma were operated by mononostril-transsphenoidal approach. Results Total removal were obtained in 23 patients with small-sized tumor,while in other 4 patients with large-sized tumor, one got total removal , three part-removal. One had inner-wall fracture of orbital cavity causing severe vision damage in one eye. Anosmia occurred in 2 cases after the operation, 7 had post-operative transient diabetes insipidus companied with water-electrolyte disorder. Conclusion In patients with giant pituitary adenoma or the tumor with sclerotic character, transcranial approach might be a better choice; To locate the anterior wall of sphenoidal sinus quickly and precisely, is a pivotal step of the operative procedure; The base of the sella can be repaired with absorbable gelatin sponge plus biological glue satisfactorily. Post-operative hyponatremia and hypochloremia must be treated promptly.