Ogawa T, Matsumoto K, Nakashima T, Okano M, Ono Y, Fukushima K, Yuuen K, Akagi H, Nishizaki K
Department of Otorhinolaryngology, Okayama University Medical School, 2-5-1 Shikata-cho, 700-8558, Okayama, Japan.
Auris Nasus Larynx. 2001 Apr;28(2):143-9. doi: 10.1016/s0385-8146(00)00098-5.
Hardy's operation with microscope has long been the standard method for pituitary adenoma. But a new approach via the nasal cavity using an endoscope has been adopted recently. In this study, the postoperative outcome as well as the preoperative evaluation of endoscopic hypophysectomy and non-endoscopic one were compared at our faculty.
We performed the non-endoscopic transnasal hypophysectomy on 18 patients and the endoscopic transnasal hypophysectomy on thirteen patients who had a pituitary lesions from February 1996 to October 1999. As to these patients the situations from preoperation through postoperation such as chief complaints, serum hormone level, final diagnosis, tumor size, as well as operating time or blood loss during the operation were discussed precisely. Then the merits and demerits of endoscopic hypophysectomy were discussed.
Five PRL-producing adenoma, three GH-producing adenoma, nine non-functioning adenoma, and two ACTH or TSH-producing adenoma were included in this discussion as endoscopic group. The age of non-endoscopic group are from 23 to 73 (49.4 in average), and they include ten males and eight females. On the other hand three PRL-producing adenoma, two GH-producing adenoma, two non-functioning adenoma, and one Rathke's cyst were included in this discussion as endoscopic group. The age of endoscopic group are from 19 to 73 (49.1 in average), and they include seven males and six females. As to non-endopscopic group the blood loss during each operation is 568 ml and operating time is 256 min in average. For endoscopic group the blood loss is 296 ml and operating time is 234 min in average.
By microsurgery in the pituitary operation with endoscopy, the minimal invasive surgery becomes possible by reducing blood loss and shortening operating time. During the operation cooperation between neurosurgeon and ENT surgeon is indispensable in order to perform hypophysectomy smoothly. The development of optical better aids and operation instruments for endonasal hypophysectomy is desired in the future. The navigation system was more useful than X-ray fluoroscopy to obtain the detailed information.
长期以来，哈代显微镜下手术一直是垂体腺瘤的标准手术方法。但最近采用了一种经鼻腔使用内窥镜的新方法。在本研究中，我们比较了本院内窥镜下垂体切除术与非内窥镜下垂体切除术的术后结果及术前评估情况。
1996年2月至1999年10月，我们对18例垂体病变患者实施了非内窥镜经鼻垂体切除术，对13例患者实施了内窥镜经鼻垂体切除术。针对这些患者，详细讨论了从术前到术后的情况，如主要症状、血清激素水平、最终诊断、肿瘤大小，以及手术时间和术中失血量。然后讨论了内窥镜垂体切除术的优缺点。
作为内窥镜组，本讨论纳入了5例分泌泌乳素的腺瘤、3例分泌生长激素的腺瘤、9例无功能腺瘤以及2例分泌促肾上腺皮质激素或促甲状腺激素的腺瘤。非内窥镜组患者年龄在23岁至73岁之间（平均49.4岁），其中男性10例，女性8例。另一方面，作为内窥镜组，本讨论纳入了3例分泌泌乳素的腺瘤、2例分泌生长激素的腺瘤、2例无功能腺瘤以及1例拉克囊肿。内窥镜组患者年龄在19岁至73岁之间（平均49.1岁），其中男性7例，女性6例。非内窥镜组每次手术的失血量平均为568毫升，手术时间平均为256分钟。内窥镜组失血量平均为296毫升，手术时间平均为234分钟。
在内窥镜辅助下的垂体手术中，通过显微手术，减少失血量和缩短手术时间使微创手术成为可能。为了顺利进行垂体切除术，神经外科医生与耳鼻喉科医生之间的术中协作必不可少。未来期望开发出光学性能更好的辅助设备和鼻内垂体切除手术器械。导航系统在获取详细信息方面比X线透视更有用。
