单鼻腔经蝶内窥镜垂体瘤手术与经口鼻蝶窦垂体瘤手术的比较研究

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1、单鼻腔经蝶内窥镜垂体瘤手术与经口鼻蝶窦垂体瘤手术的比较研究作者：胡卫星李立新傅震乔明哲顾培元吴幼章【关键词】垂体腺瘤【摘要】目的总结比较单侧鼻腔经蝶内窥镜垂体瘤手术和经口鼻蝶窦垂体瘤手术的临床疗效及特点。方法前瞻设计，将近两年75例垂体瘤病例以2∶3随机分为单鼻腔经蝶内窥镜手术（Ⅰ组29例）和经口鼻蝶窦手术（Ⅱ组46例）两组，进行比较研究。结果（1）术前两组病例临床资料无明显差异，P值均>0.05。（2）肿瘤切除率:Ⅰ组27/29;Ⅱ组39/46。（3）出血情况:术中平均输血量:Ⅰ组50ml/Ⅱ组200ml（P<0.01）。术后48h内鼻部敷料平均更换

2、次数Ⅰ组0次/Ⅱ组3次。（4）其它:①术中误伤鞍隔脑脊液漏Ⅰ组1例/Ⅱ组5例。②术后尿崩Ⅰ组3例/Ⅱ组14例。③术后内分泌功能恢复者Ⅰ组11例（11/19），Ⅱ组10例（10/32）。④术后鼻外形改变Ⅰ组0例/Ⅱ组31例，鼻纵隔穿孔Ⅰ组0例/Ⅱ组3例，蝶窦囊肿Ⅰ组0例/Ⅱ组2例。⑤术后平均住院Ⅰ组5天/Ⅱ组8.7天。两组病例均无手术死亡和感染病例。结论单鼻腔经蝶内窥镜手术深部照明清楚，无盲区，肿瘤切除彻底;具有疗效高、创伤小、恢复快、并发症少等优点，值得进一步推广。关键词垂体腺瘤内窥镜手术入路微创【Abstract】ObjectiveToevaluateendos

3、copicmonoendonasaltranssphenoidalpituitarytumorresectioncomˉ6paringwithsublabialtranssphenoidalapproach.MethodsConsecutive75casesofpituitarytumorswereprospectivelydividedintotwogroups（groupⅠ29/groupⅡ46）at2:3accordingtorandomlydesign.Theclinicalresultsandcharˉacteristicswerecomparedbet

4、weentwogroups.Results1.Therewerenosignificantdifferencesofpreoperationcliniˉcaldataintwogroups（P>0.05）.2.Ratesoftumorresectionwere27/29（Ⅰ）and39/46（Ⅱ）respectively.3.Bleedingsituation:Themeanvolumesoftransfusionwere50ml（Ⅰ）/200mlduringoperation.Numbersofnose-dressˉingrefreshingwere0（Ⅰ

5、）/3（Ⅱ）inthefirst48hrspostoperation.4.Others:①UnexpectedDiaphragmasellaedamageandtemporalCSFleakagewere1（Ⅰ）/5（Ⅱ）.②Pituitarydiabetesinsipidusinpostoperationwere3（Ⅰ）/4（Ⅱ）.③Postoperationendocrinewasrecovered（11/19）and（10/32）ingroupⅠandⅡrespectively.④Therewerenopostˉoperativenasaldiscomfor

6、t，nasalseptalperforationandsphenoidalcystinGroupⅠ.Otherwise，31，3，2werefoundreˉspectivelyingroupⅡ.⑤Meandaysofhospitalizationforpostoperationwere5（Ⅰ）/8.7（Ⅱ）.Therewerenooperaˉtivemortalityandinfection.ConclusionEndoscopicmonoendonasaltranssphenoidalsurgeryforpituitarytumorproˉvidedaperfe

7、ctilluminationduringsurgery，aswellashighertumor6whole-resection.Thistechniquebroughtforwardandexcellentclinicalresult，minimalinvasiveinjury，quickerrecovery，lowerdangerandlesscomplications.Thatshouldbepopularized.Keywordspituitarytumorendoscopetranssphenoethmoidapproachminimalinvasives

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