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目的采用双鼻-蝶入路的方法,克服常规单鼻-蝶入路鼻内镜手术操作不便的缺陷。方法选择蝶鞍区肿瘤患者37例,在鼻内镜引导下经双鼻-蝶入路暴露蝶鞍区并进行手术治疗。一侧鼻腔-鼻中隔通路供主刀进行内镜显示、切割、电凝等手术操作,另一侧通路供助手进行冲洗镜头、吸引、牵引等操作,辅助主刀进行手术操作。对于蝶窦内肿瘤采用内镜引导下切除,鞍内肿瘤则结合显微镜进行手术切除。良性肿瘤采用分块切除,恶性肿瘤采用整块切除的方法。记录双鼻蝶手术通路建立的时间和出血量,并评价暴露鞍区、蝶窦的效果,以及手术切除肿瘤的疗效和并发症。结果建立双通路的手术时间平均为23min(15～45min),出血量平均为16ml(5～40ml)。术后病理:恶性肿瘤2例,为放疗后复发鼻咽癌;良性肿瘤33例,其中垂体瘤30例,乳头状瘤、脊索瘤和骨瘤各1例;炎性假瘤2例。无围手术期死亡。结论经鼻内镜双鼻-蝶入路能充分暴露鞍区和蝶窦,并能有效克服操作空间狭窄所引起的操作不便。采用此双通路进行的手术治疗并发症少而轻,疗效满意。
Objective To overcome the shortcomings of inconvenient operation of nasal endoscopic sinus surgery by using the method of dual nasal-butterflies approach. Methods Totally 37 patients with sellar tumors were selected. Nasal endoscope was used to expose the sellar region by double nasal-butterflies approach and surgery was performed. Side of the nasal - nasal septum for the main knife for endoscopic display, cutting, coagulation and other surgical procedures, the other side of the path for the assistant to wash the lens, attract, traction and other operations, to assist the surgeon for surgical operations. For the sphenoid sinus tumor using endoscopic guided resection, the saddle tumor combined with a microscope for surgical resection. Benign tumors using sub-block resection, malignant tumor with a block removal method. Record the time and blood loss of the double nasalis bypass and evaluate the effect of exposure to the sella and sphenoid sinus and the efficacy and complications of surgical resection. Results The average time for the establishment of dual-channel surgery was 23 min (15-45 min) and the mean amount of bleeding was 16 mL (5 to 40 mL). Postoperative pathology: 2 cases of malignant tumor, recurrence of nasopharyngeal carcinoma after radiotherapy; 33 cases of benign tumors, including 30 cases of pituitary tumor, papilloma, chordoma and osteoma in 1 case; inflammatory pseudotumor in 2 cases. No perioperative deaths. Conclusion Nasal endoscopic double nasal - butterfly approach can fully expose the saddle area and sphenoid sinus, and can effectively overcome the operational space caused by the narrow operation inconvenience. Surgical treatment using this dual pathway is less and less symptomatic with satisfactory results.