摘要： 目的   总结单鼻孔直接经蝶窦入路垂体腺瘤切除术的手术并发症。方法   回顾分析2005 年10 月-2008 年6 月施行单鼻孔直接经蝶窦入路垂体腺瘤切除术患者的手术并发症及其发生原因。结果   220 例患者中无功能性腺瘤143 例，功能性腺瘤77 例；微腺瘤41 例，大腺瘤147 例，巨大腺瘤32 例。手术并发症发生率约为44.55%（98/220），其中鼻内并发症34 例（15.45%），蝶窦并发症4 例（1.82%），鞍内并发症25 例（11.36%），鞍上及鞍旁并发症8 例（3.64%），内分泌系统并发症27 例（12.27%）。共死亡4 例，手术死亡率为1.82%，死亡原因为鞍上继发性出血。结论   大多数死亡病例和并发症均发生于单鼻孔直接经蝶窦入路垂体腺瘤切除术开展早期，提示直接经鼻蝶入路切除垂体腺瘤手术安全有效。手术并发症与术者手术技巧、临床经验和治疗策略正确与否有关。

关键词: 垂体肿瘤, 腺瘤, 蝶窦, 显微外科手术, 手术后并发症

Abstract: Objective To assess surgical complications of direct endonasal transsphenoidal approach for treating pituitary adenomas. Methods Retrospective analysis was performed to assess surgical complications in a series of 220 patients with pituitary adenomas from October 2005 to June 2008. Complications were analysed according to the anatomical structures of the approach and the functional systems of pituitary gland. Results One hundred and twenty-nine females and 91 males (median age 44 years old) underwent direct endonasal transsphenoidal approach for pituitary adenomas removal. Of the pituitary adenomas, 143 were non-functioning and 77 were hormonally active. There were 41 microadenomas, 147 macroadenomas and 32 giant adenomas. All complications were recorded at 3, 6, 12 and 24 months after the procedure. The complications were divided into 5 groups. Nasal complications were seen in 34 patients (15.45% ), postoperative sphenoiditis in 4 cases (1.82% ), cerebrospinal fluid rhinorrhea in 25 cases (11.36%), suprasellar and parasellar complications in 8 cases (3.64%), and those associated with endocrine disorders of pituitary gland in 27 cases (12.27% ). Four patients died of postoperative suprasellar hemorrhage and the mortality was 1.82%. All these fatal complications occurred in the first 100 cases of the direct endonasal transsphenoidal approach. Conclusion The direct endonasal transsphenoidal approach provides a safe and effective route for removal of pituitary adenomas. The reduction of complications is not only determined by technique itself, but also by a cautious surgical strategy.

Key words: Pituitary neoplasms, Adenoma, Sphenoid sinus, Microsurgery, Postoperative complications