Koltai P J, Goufman D B, Parnes S M, Steiniger J R
Division of Otolaryngology, Albany Medical College, NY 12208.
Otolaryngol Head Neck Surg. 1994 Sep;111(3 Pt 1):197-200. doi: 10.1177/01945998941113P106.
The external rhinoplasty approach is a refinement of the well-recognized sublabial transseptal technique for transsphenoidal hypophysectomy first introduced by Cushing in 1910. This article relates our experience with 111 cases of transsphenoidal hypophysectomy performed during a 10-year period (1982-1992) and includes a detailed description of our use of the external technique. Fifty-one patients were male, and 60 were female. Ages ranged from 12 years to 80 years, with an average of 46 years. One hundred one patients had pituitary adenomas, four had craniopharyngiomas, two had inverting papillomas, and there was one each of lymphoma, metastatic prostate cancer, pituitary abscess, and posttraumatic cerebrospinal fluid leak. Nine of the operations were for recurrent adenomas. Complications included 8 symptomatic anterior septal perforations and 13 asymptomatic posterior perforations. Five had transient cerebrospinal fluid rhinorrhea, five had perioperative hemorrhages, two had minor postoperative columellar deformities, and one had injury to the internal carotid artery requiring embolization. We have found the external technique for transsphenoidal hypophysectomy to be a reliable and facile means for nasal exposure of the sphenoid sinus and pituitary gland without loss of nasal tip projection or significant cosmetic deformity.
鼻外入路是对1910年由库欣首次引入的用于经蝶窦垂体切除术的公认的唇下经鼻中隔技术的改进。本文介绍了我们在10年期间（1982 - 1992年）进行的111例经蝶窦垂体切除术的经验，并详细描述了我们对鼻外技术的应用。51例为男性，60例为女性。年龄范围为12岁至80岁，平均年龄46岁。101例患者患有垂体腺瘤，4例患有颅咽管瘤，2例患有内翻性乳头状瘤，淋巴瘤、转移性前列腺癌、垂体脓肿和创伤后脑脊液漏各1例。9例手术是针对复发性腺瘤。并发症包括8例有症状的鼻中隔前穿孔和13例无症状的后穿孔。5例有短暂性脑脊液鼻漏，5例有围手术期出血，2例有轻微的术后鼻小柱畸形，1例有颈内动脉损伤需要栓塞治疗。我们发现经蝶窦垂体切除术的鼻外技术是一种可靠且简便的方法，用于鼻内暴露蝶窦和垂体，而不会导致鼻尖突出丧失或明显的美容畸形。
