内視鏡下鼻内下垂体手術の検討 : 鼻内操作について Endoscopic Transnasal Transsphenoidal Surgery for Pituitary Tumors : Intranasal Procedures

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著者

    • 小池 修治 KOIKE Shuji
    • 山形大学医学部耳鼻咽喉科学教室 Department of Otolaryngology, Yamagata University School of Medicine
    • 太田 伸男 OHTA Nobuo
    • 山形大学医学部耳鼻咽喉科学教室 Department of Otolaryngology, Yamagata University School of Medicine
    • 青柳 優 AOYAGI Masaru
    • 山形大学医学部耳鼻咽喉科学教室 Department of Otolaryngology, Yamagata University School of Medicine

抄録

当科ではこれまで約20年来,脳神経外科の顕微鏡下経鼻中隔下垂体手術における鼻内操作と術後鼻処置に関わってきた.この術式は現在,比較的安全で侵襲の少ない方法であるため下垂体腫瘍に対する標準的術式として確立されている.しかし,近年では光学機器の発達により内視鏡下手術の適応が拡大し,国内外でいくつかの術式による内視鏡下鼻内下垂体手術の報告がなされるようになった.今回われわれは顕微鏡よりもさらに広い視野を確保でき,かつ歯齦部切開,鼻中隔粘膜の剥離も不要でより低侵襲の内視鏡下鼻内下垂体手術を31例(34回)に試みた.このうち5例は顕微鏡下手術後の再発症例である.トルコ鞍底へのアプローチは,32回で一側鼻腔より経蝶形骨洞的に行い,両側鼻腔経蝶形骨洞的アプローチ.経篩骨洞経蝶形骨洞的アブローチが各1回であった.その結累,視野,鼻内操作,手術時間,術後の鼻呼吸などの点で,顕微鏡下手術よりすぐれていた.

We have been performing intranasal procedures and postoperative nasal treatments in patients undergoing microscopic transseptal pituitary surgery for the past twenty years. This surgery is safe and minimally invasive and has become the standard procedure for removing pituitary adenomas. Recent advances in optical technology have increased the use of endoscopy in endonasal sinus surgery. Several methods for endoscopic transnasal pituitary surgery have been reported. Here, we report the results for 31 patients (34 operations) who were treated with endoscopic transnasal pituitary surgery. This technique enables the area of surgery to be visualized without requiring a sublabial incision or septal ablation to be performed. Five of the cases were for recurrences after microscopic surgery. A transsphenoidal surgical approach via a unilateral nasal cavity was used in 32 cases. For the remaining two cases, a transsphenoidal surgical approach via bilateral nasal cavities was used in 1 case, and a transethmoidal-transsphenoidal surgical approach via a unilateral nasal cavity was used in 1 case. Excellent results comparable to those of microscopic transseptal surgery were obtained. Endoscopic transnasal transsphenoidal surgery was found to have the following advantages: low-invasiveness, a wide and clear surgical view, and a relatively short operating time in the nose and sinus, especially for recurrent cases. This endoscopic procedure should therefore be considered as the first choice for pituitary surgery.

収録刊行物

  • 日本耳鼻咽喉科學會會報

    日本耳鼻咽喉科學會會報 103(3), 212-218, 2000-03-20

    The Oto-Rhino-Laryngological Society of Japan, Inc.

参考文献:  16件中 1-16件 を表示

被引用文献:  4件中 1-4件 を表示

各種コード

  • NII論文ID(NAID)
    10008574618
  • NII書誌ID(NCID)
    AN00191551
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    00306622
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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