中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2010年
23期
7-10
,共4页
基层医院%鞍区病变%微侵袭治疗
基層醫院%鞍區病變%微侵襲治療
기층의원%안구병변%미침습치료
Matrical hospital%Sella region%Microinvasional surgery
目的 探讨基层医院在蝶鞍区病变微侵袭外科治疗的可行性及最佳手术方式.方法 回顾性分析2003年7月至2009年5月收治的70例蝶鞍区病变患者的临床资料.其中垂体腺瘤56例,垂体转移癌1例,颅咽管瘤3例,鞍结节脑膜瘤2例,脊素瘤1例,空蝶鞍综合征3例,脑脊液鼻漏2例,视神经损伤2例.显微镜下经鼻一蝶入路,采取两种入路方式,手术29例,显微镜、鼻内窥镜联合应用经鼻、蝶入路手术15例,鼻内窥镜下采取两种入路方式手术26例.结果 56例垂体腺瘤全切27例,次全切24例,部分切除5例,垂体转移癌予以大部分切除,鞍结节脑膜瘤2例全切,脊索瘤1例次全切,颅咽管瘤3例部分切除,空蝶鞍综合征填塞术3例,2例术后视力改善明显,1例改善不明显,脑脊液漏2例均成功修补,视神经管减压1例效果良好,1例无效.结论 基层医院科室联合,技术、设备共享,可以在蝶鞍区病变微侵袭外科治疗方面取得突破;内镜下经鼻、蝶入路是处理鞍区病变的最佳手术方式,但不能取代显微外科手术,最大限度的利用各自的优点,在鞍区病变的治疗方面将发挥更大作用.
目的 探討基層醫院在蝶鞍區病變微侵襲外科治療的可行性及最佳手術方式.方法 迴顧性分析2003年7月至2009年5月收治的70例蝶鞍區病變患者的臨床資料.其中垂體腺瘤56例,垂體轉移癌1例,顱嚥管瘤3例,鞍結節腦膜瘤2例,脊素瘤1例,空蝶鞍綜閤徵3例,腦脊液鼻漏2例,視神經損傷2例.顯微鏡下經鼻一蝶入路,採取兩種入路方式,手術29例,顯微鏡、鼻內窺鏡聯閤應用經鼻、蝶入路手術15例,鼻內窺鏡下採取兩種入路方式手術26例.結果 56例垂體腺瘤全切27例,次全切24例,部分切除5例,垂體轉移癌予以大部分切除,鞍結節腦膜瘤2例全切,脊索瘤1例次全切,顱嚥管瘤3例部分切除,空蝶鞍綜閤徵填塞術3例,2例術後視力改善明顯,1例改善不明顯,腦脊液漏2例均成功脩補,視神經管減壓1例效果良好,1例無效.結論 基層醫院科室聯閤,技術、設備共享,可以在蝶鞍區病變微侵襲外科治療方麵取得突破;內鏡下經鼻、蝶入路是處理鞍區病變的最佳手術方式,但不能取代顯微外科手術,最大限度的利用各自的優點,在鞍區病變的治療方麵將髮揮更大作用.
목적 탐토기층의원재접안구병변미침습외과치료적가행성급최가수술방식.방법 회고성분석2003년7월지2009년5월수치적70례접안구병변환자적림상자료.기중수체선류56례,수체전이암1례,로인관류3례,안결절뇌막류2례,척소류1례,공접안종합정3례,뇌척액비루2례,시신경손상2례.현미경하경비일접입로,채취량충입로방식,수술29례,현미경、비내규경연합응용경비、접입로수술15례,비내규경하채취량충입로방식수술26례.결과 56례수체선류전절27례,차전절24례,부분절제5례,수체전이암여이대부분절제,안결절뇌막류2례전절,척색류1례차전절,로인관류3례부분절제,공접안종합정전새술3례,2례술후시력개선명현,1례개선불명현,뇌척액루2례균성공수보,시신경관감압1례효과량호,1례무효.결론 기층의원과실연합,기술、설비공향,가이재접안구병변미침습외과치료방면취득돌파;내경하경비、접입로시처리안구병변적최가수술방식,단불능취대현미외과수술,최대한도적이용각자적우점,재안구병변적치료방면장발휘경대작용.
Objective To explore the feasibility and optimal operating methods of microinvasional surgery for the occupying lesions at sella region in matrical hospital. Methods to analyse 70 cases with lesion at sella region from 2003 to 2009, including 56 patients with pituitary adenoma, 1 with metastatic carcinoma, 3 with craniopharyngioma, 2 with meningioma, 1 with chordoblastoma, 3 with empty sella syndrome, 2 with cerebrospinal rhinorrhea, 2 with optic nerve decompression. Twenty-nine patients were managed by micro transnasal-sphenoidal approach, 15 by combined application of nasal endoscope and microscope, 26 by nasal endoscope. Results Of all 56 patients with pituitary adenoma, the tumors were totally removed in 27 cases and subtotally removed in 24 cases, partial removed in 5 cases. The tumor of the patient with metastatic carcinoma was subtotally removed, totally removed in 2 cases with meningioma, subtotally removed in 1 case with chordoblastoma. Of all 3 patients with empty sella syndrome, eyesight was evidently improved in 2 cases, no changed in one. Neoplasty was done well in 2 cases with cerebrospinal rhinorrhea. Optic nerve decompression has a good effect in one, ineffective in one cases. Conclusions Microinvasional surgical therapy can get breakthrough through the alliance of clinical divisions and the share of facilities in matrical hospital. The optimal operating method is the transnasal-sphenoidal approach by nasal endoscope, but it can not replace microsurgical intervention. We should utilize respective advantages in the treatment for the occupying lesions at sella region.
