神经内镜与显微镜下经鼻蝶入路手术治疗复发性无功能性垂体腺瘤的疗效分析

Contrast study on clinical efficacy between endoscopic and microscopic surgery via transnasal-transsphenoidal approach for recurrent nonfunctional pituitary adenoma

目的比较神经内镜与显微镜下经鼻蝶入路手术治疗复发性无功能性垂体腺瘤的有效性和安全性,并探讨复发性无功能性垂体腺瘤的最佳手术方式。方法共纳入2012年10月至2019年8月43例复发性无功能性垂体腺瘤患者,分别行神经内镜下经鼻蝶入路垂体腺瘤切除术(内镜组,21例)和显微镜下经鼻蝶入路垂体腺瘤切除术(显微镜组,22例),记录术中出血量、手术时间、肿瘤切除程度、术后临床症状缓解情况、手术相关并发症(包括术中脑脊液鼻漏、垂体功能减退症、嗅觉障碍、鼻出血、术区出血)和肿瘤复发率。结果显微镜组患者术中出血量[(60.67±33.27)ml对(111.33±49.26)ml;t=0.107,P=0.030]和手术时间[(81.77±26.40)min对(168.95±45.34)min;t=0.006,P=0.000]均低于内镜组,而肿瘤切除程度、术后临床症状缓解、手术相关并发症发生率、肿瘤复发率组间差异均无统计学意义(P>0.05)。结论神经内镜和显微镜下经鼻蝶入路手术是复发性无功能性垂体腺瘤的两种常用治疗方式,均可取得满意疗效且安全性较高,二者融合将是垂体腺瘤切除术的发展趋势。

Objective To compare the clinical efficacy and safety between endoscopic andmicroscopic surgery via transnasal-transsphenoidal approach for recurrent nonfunctional pituitary adenoma,and to explore the best way of operation.Methods The clinical data of 43 patients with recurrentnonfunctional pituitary adenoma who underwent surgery via transnasal-transsphenoidal approach wereanalyzed retrospectively from October 2012 to August 2019,including 21 cases of endoscopic surgery(endoscopy group)and 22 cases of microscopic surgery(microscopy group).The bleeding volume duringoperation,operative time,tumor total resection rate,postoperative symptom remission rate,incidence rate ofpostoperative complications(including intraoperative cerebrospinal fluid leak,hypophysis function,olfactorydisturbance,epistaxis,bleeding in operation area)and tumor recurrence rate were recorded.ResultsThebleeding volume during operation[(60.67±33.27)ml vs.(111.33±49.26)ml;t=0.107,P=0.030]andoperation time[(81.77±26.40)min vs.(168.95±45.34)min;t=0.006,P=0.000]in the microscopy groupwere lower than those in the endoscopy group,but there was no significant difference in tumor totalresection rate,postoperative symptom remission rate,incidence rate of postoperative complications andtumor recurrence rate(P>0.05,for all).Conclusions Neuroendoscopic and microscopic transnasal-transsphenoidal surgery are two common methods for the treatment of recurrent nonfunctional pituitaryadenoma,which can achieve satisfactory results and high safety.The fusion of neuroendoscopy andmicroscopy is a trend of pituitary adenoma resection.