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asbryobvrz · Wysłany: Nie 19:02, 13 Mar 2011

Endoscopic transsphenoidal under local anesthesia surgery for pituitary tumors of 37 cases

Tumor. Satisfactory report is as follows, 1 Data and methods 1.1 37 patients with clinical data, 16 males. 21 females; aged 17 to 80 years 15 cases of amenorrhea and less in 4 patients, galactorrhea in 16 cases, 22 cases of decreased sexual function, headache u cases. 7 cases of decreased visual acuity, visual field defect in 2 cases, 9 cases of weak endocrine examination: PRI increased in 16 patients, GH increased in 1 case, the remaining normal. c D Check: intrasellar lesions, 02 pour l ~ 2cm, 10 例 2 ~ 3CITI, 3 例> 3CIn; saddle before the type of sphenoid sinus in 1 case; the rest of the saddle. 2 patients who had craniotomy for resection of pituitary tumors, 3 patients had taken 1.2 BRC surgical patients supine position, ECG monitoring, the basis of half an hour before surgery anesthesia. Endoscope and video system surveillance. 0.1 with 2 to Kayin Jia infiltration of the adrenal piece of cotton rope. 2 bilateral nasal mucosal surface anesthesia of 0.1 times to 2 普鲁卡因加 a little adrenaline, line the side of the nasal cavity sphenopalatine nerve block and butterfly screen recess, middle turbinate back, septal infiltration anesthesia were removed after the last middle turbinate back, after the opening part of the ethmoid sinus. Find the sphenoid sinus openings. Around the expansion of the sphenoid sinus anterior to the opening,[link widoczny dla zalogowanych], do not hurt the optic nerve, carotid artery and the nasal septum after septal artery, the coverage of the sphenoid wing and the nose hole cut edge of the mucoperiosteal flap, always turn down the nasal passages exposed vomer and nasal foramen on the wing edge. Or electric drill with a bone chisel plow out of bone embedded in one of the butterfly wings and mouth, remove the film, revolves around the anterior wall of sphenoid sinus, sphenoid sinus cavity is fully exposed. Piece of cotton land anesthetic tetracaine adrenaline sphenoid sinus mucosa, removal of the sphenoid sinus septum, sphenoid sinus wall and the saddle top end of the region revolves periosteum. In the saddle with a bone chisel end of the most prominent bone at the drilling and expand the bone hole, so that a diameter of about lcm, Shenwu hurt both sides of the carotid artery. Piece of cotton land sticking epinephrine epidural ropivacaine, and fine needle aspiration with no blood or cerebrospinal fluid out to determine after the dural coagulation. Knife and then With a tumor forceps, suction tube, scraping spoon and so on. Graded the tumor resection. 1 ~ 2CITI tumors were large full-cutting, 2 ~ 3cm for subtotal,[link widoczny dla zalogowanych],> 3cm for subtotal or decompression; not for the whole West China Medical University, Department of Otorhinolaryngology, First Affiliated Hospital (Chengdu, 610041 . Postoperative radiotherapy or x knife treatment given to the full stop bleeding, the tumor cavity filled gelatin sponge antibiotics. Mucoperiosteal flap reset, sphenoid sinus, nasal cavity filled Vaseline gauze. Removed after 48h, 3d2 the results of systemic antibiotics followed up for 6 to 35 months. Improvement of symptoms in varying degrees. 2 cases in which a visual improvement, 1 case of amenorrhea or menstrual cramps 5d after operation 37 patients had no complications occurred after 3 to discuss the side of the nasal cavity under nasal endoscopy, sphenoid pituitary tumor resection of people, from the surgical path on the road to see. Just a sinus surgery; from surgery of view. Only involves one side back and side of the middle turbinate posterior ethmoid sinus,[link widoczny dla zalogowanych], the majority of the damage than sinusitis, sinus surgery, the whole is much less damage from the sinuses of the situation. Transsphenoidal Pituitary tumor patients. Inflammation of the sinuses free, gasification is good, no bone hyperplasia, compared with sinusitis patients are easy to open; nasal and sinus mucosa was normal, blood circulation is good, easy to absorb anesthetics when anesthesia. Therefore anesthesia is better than sinusitis. Mainly as patients who had endoscopic sinus surgery experience, only open after a set of deleted sinus surgery for pituitary tumors. More than local anesthesia for sinus surgery a short time this group of patients under local anesthesia surgery. Of repeated surgery put cotton sheet, and enhance the anesthetic effect. Therefore, in operation, the patient awake, quiet, breathing, blood pressure, heart rate basically stable, indicating that local anesthesia is feasible and the advantages of surgery under local anesthesia: ① less bleeding: 37 cases of bleeding in this group the average 35m1. Most of resection of the tumor, bleeding, bleeding in the surgical path on the way we understand very little, local anesthetic solution with epinephrine appropriate; cases,[link widoczny dla zalogowanych], selection of appropriate, do not choose high blood sugar, high blood pressure,[link widoczny dla zalogowanych], GH increased, and there are cases of bone hyperplasia; tumor choose the right, do not choose to repeat the tumor invasive and saddle. ② save time, is simple: subtract the preparation before anesthesia, after intubation and general anesthesia reaction does not occur faster recovery ③ anesthesia accidents: 4 ~ 5d can be discharged from hospital after another, with patients surgery conversation, to keep abreast of results of operations under nasal endoscopy under local anesthesia and surgery for pituitary tumors, we only made some preliminary attempts, has yet to be further improved. We believe that as long as proper patient selection, experience with endoscopic sinus surgery, local anesthesia of the nasal endoscopic transsphenoidal resection of pituitary tumor, is a ~ a time-saving, convenient and economical method of operation