鼻内镜联合显微镜行蝶窦及经蝶鞍区微创手术

目的探讨经单侧鼻腔直接入路行蝶窦及经蝶鞍区微创手术的方法。方法鼻内镜下用Hardy′s撑开器外移中鼻甲,扩大鼻腔,直达并开放蝶窦前壁,联合显微镜切除病变。结果12例孤立性蝶窦炎术后窦口开放良好,症状消失。9例蝶窦囊肿、脑膜瘤一次手术切除。1例蝶窦骨瘤术后症状消失。1例外伤性失明视神经管减压,术后视力无恢复。33例垂体瘤中 18例行全切除术,12例行次全切除术,3例行大部分切除术,术后补充X刀治疗。56例术后随访6个月～3.5年,蝶窦炎、蝶窦囊肿、脑膜瘤、蝶窦骨瘤术后无复发,3例垂体腺瘤复发,无颅内及鼻腔并发症。结论鼻内镜联合显微镜经单侧鼻腔直接入路行蝶窦及经蝶鞍区手术,创伤小、时间短、出血少、并发症少、效果好,是目前较好的蝶窦及经蝶鞍区微创术式。     

内镜下经中鼻甲基板开放后筛加鼻中隔入路经蝶垂体瘤手术观察

目的观察经中鼻甲基板水平部开放后筛加鼻中隔入路经蝶窦垂体瘤手术的效果。方法50例垂体瘤患者内镜下经一侧或双侧中鼻甲基板开放后筛后加鼻中隔后段切除暴露蝶窦前壁，继之充分开放蝶窦前壁，显露鞍底切除垂体瘤。记录手术时间、出血量、住院时间、并发症（脑脊液漏、尿崩、颅内感染、神经功能损伤），术后鼻腔功能以及肿瘤全切和死亡情况。结果本组患者平均手术时间2.2 h，出血量245 ml，术后平均住院时间6.2 d，术中12例患者出现脑脊液漏，即时修补后无持续脑脊液漏发生；尿崩3例；嗅觉减退/丧失12例；术后垂体功能低下4例；无视神经损伤及颅内感染。因肿瘤压迫或卒中导致的视力下降术后均有改善。肿瘤全切率86%(43/50)，无死亡病例。结论内镜下经中鼻甲基板水平部开放后组筛窦加鼻中隔后段部分切除后充分开放蝶窦前壁显露鞍底及蝶窦内解剖结构，继而切除垂体瘤的方法，视野清晰、肿瘤全切率高、微创安全、对鼻腔鼻窦功能保护好。值得临床推广应用。     

经单鼻孔蝶窦入路显微镜下切除垂体腺瘤

目的探讨经单鼻孔蝶窦入路显微镜下切除垂体腺瘤的手术方法和疗效。方法对28例垂体腺瘤的病人采用经单鼻孔蝶窦入路行显微镜下垂体腺瘤摘除术,其中微腺瘤18例,大腺瘤10例;功能腺瘤20例,其中催乳素瘤10例、生长激素腺瘤5例、促肾上腺皮质激素腺瘤3例、促性腺激素腺瘤2例;无功能腺瘤8例。结果显微镜下全切除肿瘤20例,次全切除5例,大部分切除3例;术后无1例死亡,无脑水肿、视神经损伤、鼻中隔穿孔以及鼻腔粘连等并发症;术后所有病人血清激素水平均较术前有明显下降,随访3～6个月,未见影像学下的肿瘤复发。结论显微镜下经单鼻孔蝶窦入路切除垂体瘤具有鼻腔结构损伤小、术后并发症少、病人恢复快等优点。     

内镜下经鼻蝶窦垂体瘤切除术患者鼻部相关生存质量研究

垂体瘤是以垂体前叶腺瘤为主的颅内肿瘤,手术治疗是最有效的治疗方法。随着内镜下经鼻蝶窦垂体瘤切除术的发展,经典的显微镜下鼻中隔-蝶窦垂体瘤术式逐渐受到限制;而内镜下经鼻蝶窦垂体瘤切除术因创伤小、并发症少而成为垂体瘤切除的最佳手段〔1-2〕。但经鼻内镜下切除垂体肿瘤时,可能对鼻腔的相关结构如上鼻甲、后组筛房以及蝶窦等进行处理〔1-2〕,这种创伤对于患者鼻部相关的生存质量产生何种程度的影响至今尚缺乏相关性研究。     

鼻内镜与手术显微镜配合经鼻-蝶窦行垂体瘤手术

目的探讨鼻内镜和显微外科技术结合应用于经鼻-蝶窦入路行垂体瘤手术的价值。方法在全麻下先经一侧鼻孔在内镜下寻找蝶窦开口,在内镜下完全打开双侧蝶窦前壁。蝶嵴上下留一部分残迹,作为中线定位的标志。然后在显微镜下切除垂体腺瘤。结果36例中30例肿瘤全部切除,6例近全切。术后视野缺损、偏盲、视力减退、泌乳、闭经及头痛等症状均有改善。术后随访1~4年,无复发。结论采用鼻内镜与显微镜结合应用于经蝶垂体瘤切除术,在内镜引导下具有定位准确,双目显微镜下允许双手操作,可克服各自的缺点,取长补短,并有良好的术野,术后并发症少,符合微创手术原则。     

鼻内镜下鼻蝶入路垂体腺瘤显微切除术19例

目的：探讨鼻内镜下鼻中隔-蝶窦入路垂体腺瘤显微切除术的方法及并发症的预防。方法：采用唇龈沟切口鼻内镜下经鼻中隔一蝶窦径路显微切除垂体腺瘤19例,肿瘤施行囊内切除并用无水乙醇烧灼．用唇筋膜和鼻中隔骨片重建鞍底,其中肿瘤全切除17例,次全切除2例。结果：7例术前视力损害者中6例得到不同程度的恢复,所有病例症状改善,术后除1例视力一过性减退和2例嗅觉一过性减退外,其余病例均无脑脊液鼻漏和脑膜脑膨出等并发症。术后随访3个月～3年,17例全切除者肿瘤无复发,2例次全切除者肿瘤生长缓慢。结论：采用鼻中隔一蝶窦入路垂体腺瘤显微切除术,术中囊内烧灼可有效地防止或减缓术后肿瘤复发。术后唇筋膜和鼻中隔骨片重建鞍底可防止相应并发症。     

鼻内镜下垂体腺瘤切除术--附28例报告

目的:探讨鼻内镜下垂体腺瘤手术的治疗经验。方法:鼻内镜下经鼻中隔-蝶窦、鼻内镜辅助经鼻中隔-蝶窦和经鼻腔-蝶窦三种入路手术行垂体腺瘤切除术,共28例。结果:Hardy-Wilson分级Ⅰ级者7例全切除;Ⅱ级者7例,5例全切除,2例次全切除;Ⅲ级者11例,5例全切除,5例次全切除,1例部分切除;Ⅳ级者3例,部分切除。严重并发症蛛网膜下腔出血1例,死亡1例。术后随访2个月～56个月,手术全切除17例中1例复发。结论:鼻内镜下垂体腺瘤手术克服了显微镜下不能观察蝶窦外侧壁重要血管和神经等结构的缺点,经鼻内镜垂体腺瘤切除术具有操作简单、到达蝶鞍比较容易、损伤小的优点,符合微创外科手术原则。     

鼻内镜下鼻蝶入路垂体腺瘤显微切除术(附19例报告)

目的探讨鼻内镜下鼻中隔蝶窦入路垂体腺瘤切除术的方法及并发症的防止。方法唇龈沟切口鼻内镜下经鼻中隔蝶窦径路显微切除垂体腺瘤19例,16例微腺瘤施行全切,3例大腺瘤行囊内次全切除并用无水酒精烧灼,全部病人用唇筋膜和鼻中隔骨片重建鞍底。结果肿瘤全切除16例,次全切除3例。7例术前视力损害者6例得到不同程度的恢复,所有病例症状改善,术后除1例视力一过性减退和2例嗅觉一过性减退外,其余病例均无脑脊液漏和脑膜脑膨出等并发症。术后随访3~36个月,16例肿瘤无复发,3例次全切除者肿瘤生长缓慢。结论鼻内镜唇下-鼻中隔-蝶窦入路是切除垂体腺瘤的较理想径路,术中囊内烧灼可有效地防止或减缓术后肿瘤复发,术后唇筋膜和鼻中隔骨片重建鞍底可防止相应并发症。     

鼻内镜下垂体腺瘤切除术——附28例报告

目的：探讨鼻内镜下垂体腺瘤手术的治疗经验。方法：鼻内镜下经鼻中隔-蝶窦、鼻内镜辅助经鼻中隔-蝶窦和经鼻腔-蝶窦三种入路手术行垂体腺瘤切除术，共28例。结果：Hardy-Wilson分级Ⅰ级者7例全切除；Ⅱ级者7例，5例全切除，2例次全切除；Ⅲ级者11例，5例全切除，5例次全切除，1例部分切除；Ⅳ级者3例，部分切除。严重并发症蛛网膜下腔出血1例，死亡1例。术后随访2个月～56个月，手术全切除17例中1例复发。结论：鼻内镜下垂体腺瘤手术克服了显微镜下不能观察蝶窦外侧壁重要血管和神经等结构的缺点，经鼻内镜垂体腺瘤切除术具有操作简单、到达蝶鞍比较容易、损伤小的优点，符合微创外科手术原则。     

经鼻蝶入路垂体瘤切除术后并发蝶窦炎的分析及处理

目的 探讨经鼻蝶入路垂体瘤切除术后并发蝶窦炎的防治方法。 方法 129例患者行经鼻蝶入路垂体瘤切除术,统计术后并发蝶窦炎患者,对其进行处理。 结果 经鼻蝶入路垂体瘤切除术后并发蝶窦炎6例(4.65%),经鼻内镜下定期术腔清理、鼻用激素、鼻腔冲洗后全部治愈。 结论 对经鼻蝶入路垂体瘤切除术后并发蝶窦炎患者行鼻内镜下及时处理,可有效改善患者临床症状。     

鼻内镜单侧蝶窦入路显微手术切除垂体腺瘤(附17例报道)

目的探讨鼻内镜在经鼻腔一蝶窦垂体腺瘤显微手术中的作用。方法采用鼻内镜辅助下单侧蝶窦人路手术治疗垂体腺瘤17例。结果肿瘤全切15例,次全切2例,症状得到改善,术后无脑脊液鼻漏、鼻中隔穿孔及其它手术并发症。结论采用鼻内镜技术与显微外科技术相结合在经鼻腔一蝶窦垂体腺瘤切除术中具有优势互补的作用,有利于实现微创手术的目的。     

经鼻内镜鼻中隔蝶窦径路垂体腺瘤切除术

目的：探讨经鼻内镜中隔一蝶安径路行垂体腺瘤印除术的方法。方法：对23例垂体腺瘤患者采用经鼻内镜中隔一蝶窦径路垂体腺瘤显微切除术。结果：23例垂体腺瘤均完全切除,手术时间短,术中平均出血量为50ml,术后平均住院日6d,术后无严重并发症。结论：与经蝶人路显微外科手术和鼻内镜下经蝶垂体腺瘤手术相比,经鼻内镜中隔一蝶窦径路垂体腺瘤切除术实现了经蝶人路显微外科手术和鼻内镜下经蝶垂体腺瘤手术的优势互补,手术创伤小,操作方便,切除彻底。具有良好的鼻内镜操作和显微手术技能,选择适当的适应证,可以达到理想的效果.     

Transphenoidal endoscopic approaches for pituitary adenomas: a critical review of our experience

BackgroundThe surgical approach to the pituitary fossae has evolved from transcranial to sublabial and transseptal microscopic ones, up to the current transsphenoidal endoscopic approach.ObjectivesTo present our experience in the transnasal transsphenoidal approach for pituitary adenomas and the modifications introduced to improve tumoral resection and to lower iatrogenia.Material and methodsOver nine years, we operated on 37 patients with pituitary adenomas using the transsphenoidal endoscopic approach. We utilised optical lens of 0° (approach) and 30° (adenoma resection), optic navigator, surgical instruments for nasal endoscopic and pituitary surgery. During the neurosurgical step, the endoscope was fixed by an articulated arm. We acceded to the pituitary fossae by a bilateral sphenoidotomy.ResultsSphenoid pneumatisation was sufficient in all the patients. The more common postoperative complications were diabetes insipidus and endocrinology deficiencies. Postoperative rhinoliquorrhea affected only one patient. No alterations of nasal fossae were observed. Mean patient hospitalisation was five days.ConclusionsTranssphenoidal endoscopic approach guided by navigator gives significant advantages: Shorter operating time and fewer complications, greater safety and preservation of the nasal passages. Resecting the sphenoidal rostrum and a fragment of adjacent nasal septum improves surgical instrument management into the pituitary fossae and therefore adenoma resection. Endoscope fixation stabilises the vision and allows the second surgeon to help more effectively.     

Endoscopic transnasal transsphenoidal surgery for pituitary tumors--intranasal procedures

We have been performing intranasal procedures and postoperative nasal treatments in patients undergoing microscopic transseptal pituitary surgery for the past twenty years. This surgery is safe and minimally invasive and has become the standard procedure for removing pituitary adenomas. Recent advances in optical technology have increased the use of endoscopy in endonasal sinus surgery. Several methods for endoscopic transnasal pituitary surgery have been reported. Here, we report the results for 31 patients (34 operations) who were treated with endoscopic transnasal pituitary surgery. This technique enables the area of surgery to be visualized without requiring a sublabial incision or septal ablation to be performed. Five of the cases were for recurrences after microscopic surgery. A transsphenoidal surgical approach via a unilateral nasal cavity was used in 32 cases. For the remaining two cases, a transsphenoidal surgical approach via bilateral nasal cavities was used in 1 case, and a transethmoidal-transsphenoidal surgical approach via a unilateral nasal cavity was used in 1 case. Excellent results comparable to those of microscopic transseptal surgery were obtained. Endoscopic transnasal transsphenoidal surgery was found to have the following advantages: low-invasiveness, a wide and clear surgical view, and a relatively short operating time in the nose and sinus, especially for recurrent cases. This endoscopic procedure should therefore be considered as the first choice for pituitary surgery.     

鼻内镜扩大经鼻蝶窦入路切除巨大垂体腺瘤13例

目的:探讨鼻内镜扩大经蝶窦入路切除巨大垂体腺瘤的可行性。方法:回顾性分析2000～2003年 间通过鼻内镜扩大经蝶手术入路治疗的13例巨大垂体腺瘤的临床资料。结果:所有患者术中镜下全部切除肿 瘤,术后10例患者给予放射治疗;术后影像学检查显示肿瘤有残余者6例,平均随访12个月肿瘤无复发或继续 生长。术后发生短暂性尿崩症6例,脑脊液鼻漏2例及急性腺垂体功能低下者1例;无死亡及颅内感染,无鼻腔 通气障碍、鼻腔粘连、鼻中隔穿孔等并发症。结论:扩大经蝶手术是治疗巨大垂体腺瘤的一种可行、安全、有效的 方法,但应掌握熟练的经蝶手术技术;术后应给予放射或药物辅助治疗。     

Unexpected prominent tension pneumosella five years after endoscopic endonasal transsphenoidal surgery

Tension pneumosella (TP) is a rare entity reported as the invagination of the sphenoid sinus mucosa into the skull base after endonasal transsphenoidal surgery. Few studies have reported on TP, and in these studies, invagination is confined to either the intrasellar or suprasellar area. We encountered a case of unexpected prominent TP toward the intracranial space 5 years after endoscopic endonasal transsphenoidal surgery (EETS) for a nonfunctioning pituitary adenoma. In addition, we present a hypothesis of the underlying mechanism by a pressure gradient change between the extracranial and intracranial space in TP formation. For repair, a pedicled nasal septal flap was fabricated from the remaining part of the septal mucosa, and a pedicled inferior turbinate flap was created. Moreover, the nasal septal cartilage was used as a rigid support for reconstruction, which was useful for preventing TP recurrence. This is the first report of an unexpected prominent TP after EETS. It is important for otorhinolaryngologists and neurosurgeons to be aware of the possibility of TP following EETS. Laryngoscope, 1798–1801, 2018     

内镜经扩大鼻蝶入路切除鞍上肿瘤的临床分析

目的探讨内镜经扩大鼻蝶入路切除鞍上肿瘤、鞍内向鞍上或向前颅底扩展肿瘤的安全性和有效性。方法回顾性分析了2013年11月~2015年7月内镜经扩大鼻蝶入路切除鞍上肿瘤、鞍内向鞍上或前颅底扩展肿瘤17例;其中颅咽管瘤6例、向鞍上或前颅底扩展垂体瘤9例、垂体柄朗格罕斯组织细胞增生症1例、视交叉海绵状血管瘤1例。结果14例（14/17,82.4%）全切除,2例颅咽管瘤近全切除,1例颅咽管瘤次全切除后接受伽马刀治疗。15例术前视力下降,14例（14/15,93.3%）术后视力改善;1例（6.7%）术后视力障碍加重,2周后恢复至术前水平。11例术前皮质醇正常,2例(2/11,18.2%)术后出现一过性降低。2例生长激素增高,术后正常。1例（1/17,5.9%）垂体瘤术后脑脊液鼻漏,二次手术修补。随访3~24个月,MRI未见肿瘤复发,无死亡患者。结论内镜经扩大鼻蝶入路从腹侧显露和切除鞍上肿瘤,视野清晰、无脑牵拉损伤,能更好地保护神经功能,是切除鞍上肿瘤的一种安全、有效的方法。