神经内镜与显微镜下单鼻孔切除垂体腺瘤的对比研究

Comparison of Neuroendoscopy and Microscopy for Transnasal Resection of Pituitary Tumors

目的比较内镜与显微镜下经单鼻孔-经蝶窦入路切除垂体腺瘤的疗效。方法 2007年10月~2008年10月,24例适合经蝶入路手术的垂体瘤选择显微镜下单鼻孔-经蝶窦入路（显微镜组）。2008年11月~2009年10月,16例适合经蝶入路手术的垂体瘤全部选择内镜下单鼻孔-经蝶入路（内镜组）。结果内镜组16例肿瘤全切除,全切率为100%,显微镜组23例肿瘤全切除,1例大部切除,全切除率为95.8%（23/24）。内镜组手术时间（3.1±1.0）h显著长于显微镜组（2.2±0.4）h（t=3.977,P=0.000）;住院时间（8.6±1.1）d显著短于显微镜组（11.2±1.2）d（t=-6.935,P=0.000）。显微镜组术后并发鼻窦炎症3例,鼻中隔缺损8例,脑脊液漏1例;内镜组术后一过性尿崩1例。2组术后并发症发生率有统计学差异（P=0.005）。40例随访3~12个月,平均6.2月,无肿瘤复发。结论神经内镜和显微镜下单鼻孔-经蝶入路垂体瘤切除术疗效满意,安全。

Objective To compare the efficacy of transnasal endoscopic and microscopic resection of pituitary tumor.Methods From October 2007 to October 2008,24 cases of pituitary tumors which could be resected by transsphenoidal approach were selected to undergo microscopic surgery via transsphenoidal single-nostril resection（microscope group）.And then from November 2008 to October 2009,16 cases of pituitary tumors who showed indications for transsphenoidal surgery received endoscopic resection through transsphenoidal single-nostril approach（endoscope group）.Results In the endoscope group,the 16 tumors were totally removed with a complete resection rate of 100%.And in the microscope group,23 tumors were totally removed and 1 tumor was subtotally removed（rate of complete resection 95.8%）.The endosocope group showed significantly longer operation time [（3.1±1.0） h vs.（2.2±0.4） h,t=3.977,P=0.000],and shorter hospital stay [（8.6±1.1） d vs.（11.2±1.2） d,t=-6.935,P=0.000].In the microscope group,postoperative sinusitis was developed in 3 cases,nasal septum defect in 8 cases,and cerebrospinal fluid leakage in 1 case.Whereas in the endoscope group,postoperative complications only occurred in one patient（transient diabetes insipidus）.Follow-up was available in both groups（40 cases in total） for 3 to 12 months with a mean of 6.2 months.No tumor recurrence was found in the patients.Conclusion Both endoscopic and microscopic resection of pituitary tumors through transsphenoidal approach are effective and safe.