CAJ | 학술논문

目的:探讨经单鼻孔蝶窦入路显微手术治疗垂体腺瘤的经验与方法.方法:回顾总结显微镜下单鼻孔经蝶窦入路切除46例垂体腺瘤,观察手术效果和并发症.具体手术方法是:将鼻窥器缓慢插入右鼻孔向上经中鼻甲直至蝶窦前壁,横行切开鼻中隔黏膜约1.5cm,保持窥器尖呈闭合状态向对侧偏移,使鼻中隔骨折移位.然后将窥器张开,此时在显微镜下即可见中线骨性隆起结构蝶嵴及两侧蝶窦开口.以蝶嵴及两侧蝶窦开口为标志,凿除蝶窦前壁约1.0～1.5cm,显露蝶窦腔,咬除蝶窦分隔,剥离电凝蝶窦黏膜,显露凸形鞍底,凿开并咬成1.2～1.5cm骨窗既见硬脑膜,电凝硬膜后穿刺,证实肿瘤后"十"字切开,显露肿瘤并予钳取和刮除.通常肿瘤切净后可见鞍隔塌陷,彻底止血,冲洗术腔,放入明胶海绵填塞.结果:手术过程顺利,肿瘤全切除34例,次全切除12例,无死亡及病残发生,激素水平均有明显改善,17例出现一过性尿崩症,5例出现电解质紊乱,术后无脑脊液鼻漏发生.结论:不断改进的单鼻孔经蝶窦入路具有入路简捷、操作方便、安全高效的优点.
목적:탐토경단비공접두입로현미수술치료수체선류적경험여방법.방법:회고총결현미경하단비공경접두입로절제46례수체선류,관찰수술효과화병발증.구체수술방법시:장비규기완만삽입우비공향상경중비갑직지접두전벽,횡행절개비중격점막약1.5cm,보지규기첨정폐합상태향대측편이,사비중격골절이위.연후장규기장개,차시재현미경하즉가견중선골성륭기결구접척급량측접두개구.이접척급량측접두개구위표지,착제접두전벽약1.0～1.5cm,현로접두강,교제접두분격,박리전응접두점막,현로철형안저,착개병교성1.2～1.5cm골창기견경뇌막,전응경막후천자,증실종류후"십"자절개,현로종류병여겸취화괄제.통상종류절정후가견안격탑함,철저지혈,충세술강,방입명효해면전새.결과:수술과정순리,종류전절제34례,차전절제12례,무사망급병잔발생,격소수평균유명현개선,17례출현일과성뇨붕증,5례출현전해질문란,술후무뇌척액비루발생.결론:불단개진적단비공경접두입로구유입로간첩、조작방편、안전고효적우점.
Objective: To explore the effect of single-nostril transsphenoidal approach on pituitary adenoma. Methods: We retrospectively analyzed 46 cases of pituitary tumors treated with single-nostril transsphenoidal approach and the effects and complications of surgery.Dunng the surgery,a nasal speculum was inserted through right nostril slowly towards the anterior wall of sphenoid sinus.A nasal mucosa incision of about 1.5cm was made in the right nasal cavity at the level of the middle nasal turbinate.With a fracture of the bony septum,a space was developed between the bilateral nasal mucosa and bony septum to the sphenoid sinus.Then,the face of the sphenoid sinus was exposed.The remainder of the bony septum,the anterior sphenoid sinus wall,and the sphenoid mucosa were removed.The antenor sphenoidotomy should be less than 1.5cm wide.After confirming the tumor by dural puncture,a cross incision of dura was made and the tumor was removed.The saddle was usually Collapsed and visible after total tumor removal.When the tumor was resected,sevaral gelatin sponges were stuffed into the Surgical cavity to stop bleeding. Results: Thirty-four cases had total resection and 12 cases had subtotal resection.No deaths or disability occurred.Hormone levels in almost all patients were improved.Seventeen cases had a sign of diabetes insipidus.Electrolyte disturbance occuwed in 5 cases.NO postoperative cerebrospinal fluid rhinorrhea was observed. Conclusion: Single-nostril transsphenoidal approach has many advantages in treating pituitary adenomas such as simplified approach,brief technology and high security.