内镜经鼻扩大入路与显微经鼻入路手术切除垂体瘤的对比研究

Comparative study of endoscopic extended nasal approach and microscopic transnasal approach for pituitary tumors resection

目的观察内镜经鼻扩大入路(EEA)与显微经鼻入路在垂体瘤切除术中的应用情况。方法回顾性分析2015年2月~2017年2月我院56例垂体瘤患者的临床资料,将行EEA垂体瘤切除术的30例患者纳入研究组,将行显微经鼻入路垂体瘤切除术的26例患者纳入对照组。观察垂体瘤切除情况,于术前(T1)、术后第2天(T2)检测两组患者血清激素[泌乳素(PRL)、生长激素(GH)、促肾上腺皮质激素(ACTH)]水平,术中鞍底、鞍膈显露情况,肿瘤显露及切除情况,鞍膈破裂情况,记录脑脊液漏发生、术后肿瘤残留情况。结果 T2时,两组PRL、GH水平均较治疗前降低,且研究组降幅大于对照组,差异均有统计学意义(P均<0.05),两组ACTH水平组间及与同组T1时比较差异均无统计学意义(P均>0.05);研究组脑脊液漏发生、术后肿瘤残留发生率低于对照组,垂体瘤全切率大于对照组,差异有统计学意义(P<0.05)。结论 EEA垂体瘤切除术对改善患者激素水平、提高垂体瘤全切率有一定帮助,且术后并发症较少,于改善患者预后。

Objective To observe the application of endoscopic extended nasal approach（EEA） and micro transnasal approach in pituitary adenoma resection. Methods The clinical data of 56 patients with pituitary tumor in our hospital from February 2015 to February 2017 were analyzed retrospectively.Thirty patients who underwent EEA pituitary adenectomy were included in the study group.Twenty-six cases of pituitary adenoma resection by microsurgery through nasal approach were included in the control group.The levels of serum hormones [prolactin（PRL）,growth hormone（GH） and adrenocorticotropin（ACTH） were detected in two groups of patients before surgery（T1） and second days after operation（T2）.The exposure of the sellar and saddle diaphragm,the exposure and resection of the tumor and the rupture of the diaphragmatic diaphragma were observed.The occurrence of cerebrospinal fluid leakage and tumor residual after operation were recorded. Results At the time of T2,the levels of PRL and GH in the two groups were all lower than those before treatment,and the decrease in the study group was larger than that in the control group（P 0.05）.There was no significant difference in the ACTH level between the two groups and the T1 in the same group（P 0.05）.The incidence of cerebrospinal fluid leakage and postoperative residual tumor in the study group was lower than that in the control group,and the total resection rate of pituitary tumor was larger than that in the control group（P 0.05）. Conclusion EEA pituitary tumor resection is helpful to improve the hormone level and improve the total resection rate of pituitary adenoma,and has fewer postoperative complications,which can improves the prognosis of patients.