經鼻小柱路徑以內視鏡經鼻中隔及蝶竇行腦下垂體手術

背景：近10幾年來，因鼻竇內視鏡手術的發展與進步，目前已廣泛應用內視鏡經蝶竇行腦下垂體手術。雖然手術的路徑有多種選擇，但在少數患者仍會造成術中器械操作的限制。本文採用經鼻小柱路徑(transcolumellar approach)以增加手術視野及器械操作容易度。方法：從2004年8月至2005年3月，共有10名腦下垂體腫瘤患者接受以開放式鼻成形手術之經鼻小柱路徑，施行內視鏡經鼻中隔及蝶竇腦下垂體手術，進行回溯性分析。結果：10名患者中，男性6名，女性4名，平均年齡43.1歲。診斷皆為大於1cm的腦下垂體巨大腺瘤，其中2名男性患者為具功能性的泌乳激素瘤。9名病患術後症狀改善，另l名因症狀持續接受第二次手術。無任何病人術後手術出血或腦脊髓液外漏等併發症。術後追蹤鼻部無鼻中隔血腫、鼻腔黏膜沾黏或鼻中隔穿孔產生，且外觀無缺陷或明顯疤痕。結論：本文採用的經鼻小柱路徑手術技巧，具有解剖正中對稱性、手術視野加大且便於器械操作，尤其對於小鼻孔、鼻中隔彎曲、鼻甲肥厚或鼻腔異常的患者，更是提供內視鏡經蝶竇腦下垂體腫瘤手術之另一種路徑的選擇。

關鍵字

內視鏡；開放式鼻成形術；腦下垂體腫瘤；經鼻小柱路徑；經蝶竇手術

並列摘要

BACKGROUND: Sublabial and transnasal approaches have been traditionally used as the routine technique for transsphenoidal pituitary surgery. The sublabial approach is more widely-used and may cause much more morbidity than the transnasal approach which could be applied in fewer patients who have large nostrils. In the recent decade, endoscopic transsphenoidal surgical technique has emerged as a new method to perform pituitary surgery. METHODS: From August 2004 to March 2005, 10 patients at the Tri-Service General Hospital underwent endoscopic transseptal transsphenoidal pituitary surgery by open rhinoplasty via the transcolumellar approach. RESULTS: Six males and four females ranging in age from 19 to 74 years with a mean age of 43.1. In 9 cases of this study, there were significant improvements in symptoms. There was no CSF leakage or bleeding postoperatively. There was no depression of the nasal tip and obvious columellar scar and no setpal hematoma or synechiae. CONCLUSION: This approach opens a generous operative exposure and affords symmetry of anatomical midline of the surgical field without limited endoscopic operative maneuverability. We conclude that this technique is an alternative for pituitary surgery, especially in patients with small nostrils, septal deviation and choncha hypertrophy or other sinonasal abnormalities.

並列關鍵字

endoscope ； open rhinoplasty ； pituitary tumor ； transcolumellar approach ； transsphenoidal surgery

國際替代計量

經鼻小柱路徑以內視鏡經鼻中隔及蝶竇行腦下垂體手術

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