摘要目的 评价应用神经内镜辅助、经单鼻孔-蝶窦入路切除垂体腺瘤(PAs)的微侵袭手术技术、鞍底重建与疗效.方法 从2001年4月至2009年3月,对第四军医大学西京医院连续收住院的426例PAs患者行神经内镜下经单鼻孔-蝶窦入路手术.本组病例根据Hardy's PAs分类标准:Ⅰ型54例(12.7%),Ⅱ型105例(24.6%),Ⅲ型181例(42.5%),Ⅳ型86例(20.2%).结果 肿瘤切除根据术术中所见及术后MRI或CT扫描进行评估,370例(86.9%)肿瘤获全切除,32例(7.5%)达次全切除,余24例(5.6%)纤维性肿瘤获部分切除.本组术后3例死亡(0.7%),24例(5.6%)发生CSF漏而须行修补术,6例(1.4%)有蝶窦黏膜炎和脑膜炎,用药物治疗得以控制.结论 质地稍软的PAs无论有无鞍上扩展、但未侵及血管者,在神经内镜下经单鼻孔-蝶窦入路、术中将内镜变换角度,可获得安全而满意的切除.

abstractsObjective To evaluate the effect of surgical technique and clinical curative effect for a unilateral endonasal-transsphenoidal approach in the removal of pituitary adenomas (PAs) by an endoscopeassisted technique with sellar floor reconstruction. Methods Between April 2001 and March 2009, 426 consecutive patients underwent extended neuroendoscopic unilateral endonasal transsphenoidal surgery. The series consisted of 54( 12.7% ) as I type of Pas and 105 ( 24. 6% ) Ⅱ type, 181 (42. 5% ) Ⅲ type and 86 (20. 2% ) Ⅳ type according to Hardy's classification criteria of pituitary adenoma. Results Tumor removal,as assessed by intraoperative findings and postoperative magnetic resonance imaging or CT scans, revealed complete tumor removal in 370 cases (86. 9% )and subtotal tumor removal in 32 cases (7. 5% ) were achieved. Partial removal was carried out in the remaining 24 cases (5.6%) with fibrous tumor. Three patients (0. 7% ) had postoperative death in this group. Twenty-four patients (5. 6% ) had a postoperative cerebrospinal fluid leak that required repair operations. Six patients (1.4%) experienced a sphenoid mucositis and meningitis and they were cured by medical therapy. Conclusion The slightly soft texture of PAs with or without a limited suprasellar extension and without involvement of vascular structures, may be resected through such an extended neuroendoscopic transsphenoidal approach. Intraoperative angled endoscope is a useful adjunct for safe removals.