Objective: To observe the clinical efficacy and safety of endoscopic sinus surgery for pituitary adenomas. Methods: 197 cases with pituitary adenoma treated by single nasal endoscopic surgery were selected in our hospital, including 105 cases treated by endoscopic surgery (endoscopic group) and 92 cases treated by microscope surgery (microscope group). The operation time, blood loss, total tumor resection rate, postoperative hospital stay and postoperative complications, 1-year follow-up recurrence rate and decrease ratio of endocrine hormones were compared between the two groups. Results: The bleeding volume, operative time, hospitalization time, 1 year recurrence rate and postoperative complications (diabetes insipidus, low potassium hyperlipidemia, visual impairment, intracranial hematoma, nasal bleeding) occurrence rate were lower than those of the microscope group; total tumor removal rate and endocrine hormone reduction rate were higher than those of the microscope group, the difference was statistically significant (P<0.05). Conclusion: The clinical efficacy of endoscope assisted by nasal transsphenoidal pituitary adenoma resection operation is remarkable, with shorter operation time, intraoperative blood loss less, postoperative hospitalization time, stronger safety, and the complication rate is low; it is worth in clinical promotion.