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目的介绍内窥镜在23例经蝶垂体腺瘤手术中的应用经验，结合国外文献，探讨今后发展。方法23例经蝶垂体腺瘤手术中，应用新亚医用光学仪器厂提供的垂体内窥镜硬Ⅰ型与Ⅱ型进行术中瘤腔盲区的窥视，对残留肿瘤作进一步清除。对个别质地坚韧或侵袭海绵窦而出血多的腺瘤，为确保安全，未作全切。结果内窥镜对肿瘤残腔检视12例无残留，3例有残留作了进一步清除，4例残腔小，视野呈一片红色，不够清晰；肿瘤偏硬或侵袭海绵窦易出血各2例，均难以彻底切除。术后临床症状体征与内分泌有不同程度改善，计算机体层摄影（CT）和（或）磁共振成像（MRI）检查显示肿瘤全切11例，可疑残留或小块残留各4例，残留较多3例，1例尚待随访。3－5年以上长期随访的11例病人中7例痊愈，余4例术后放射治疗后病情稳定。结论垂体内窥镜术中检机，有利于提高经蝶垂体腺癌手术的彻底性。加强垂体内窥镜手术中识别能力，熟练操作，进行有效的冲水与吸引，保持镜面清晰，至关重要；设计新的机械臂固定调节装置，改进手术器械等方面有待完善，对部分质硬或长入海绵窦的侵袭性腺瘤不可强求全切。
Objective To introduce the experience of endoscopic application in 23 cases of transsphenoidal pituitary adenoma surgery, and to explore the future development of the endoscope combined with foreign literature. Methods Twenty - three cases of transsphenoidal pituitary adenoma were treated with pituitary endoscopic hard Ⅰ and Ⅱ type plexus provided by New Asia Medical Optical Instrument Factory. The residual tumor was further removed. On the individual tough or invasion of cavernous sinus hemorrhage and more adenomas, to ensure safety, not for the whole cut. Results Endoscopic examination of the residual tumor in 12 cases without residual, 3 cases of residual were further cleared, 4 cases of residual cavity, the field of vision was a red, not clear enough; tumor hard or invasion of cavernous sinus bleeding in 2 cases, It is difficult to completely remove. Postoperative clinical signs and signs and endocrine have varying degrees of improvement, computed tomography (CT) and (or) magnetic resonance imaging (MRI) examination showed that the tumor was completely resected in 11 cases, 4 cases of suspicious residues or small residues, residual more 3 cases, 1 case yet to be followed up. Seven of 11 patients with long-term follow-up of more than 3-5 years recovered, and the remaining 4 patients were stable after radiotherapy. Conclusion Pituitary endoscopy in the examination, is conducive to improving the thoroughness of transsphenoidal pituitary adenocarcinoma surgery. It is very important to strengthen the identification ability and proficiency in pituitary endoscopic surgery, to flush and attract effectively and keep the mirror clear. It is very important to design a new fixed arm manipulator and improve surgical instruments, Or invasive cavernous sinus adenoma can not force the whole cut.