神经内镜与显微镜下经鼻蝶垂体腺瘤切除术效果对比分析

Comparative analysis of neuroendoscopic and microscopic trans-nasal-sphenoidal pituitary adenoma resection

目的:探讨神经内镜与显微镜下经鼻蝶垂体腺瘤切除术的手术效果。方法:回顾分析2009年12月至2012年12月收治的263例患者的临床资料,其中105例行神经内镜垂体腺瘤切除术(内镜组),158例行显微镜下经鼻蝶入路垂体腺瘤切除术(显微镜组),对比分析两组患者手术时间、出血量、手术切除率、术后并发症发生率、术后住院时间等指标。结果:内镜组手术时间较显微镜组长[(78.7±34.55)min vs.(66.8±31.32)min](P=0.014);两组术中出血量差异无统计学意义[(60.6±32.35)ml vs.(55.1±24.63)ml](P=0.943);两组手术全切率差异亦无统计学意义(93.3%vs.92.4%)(P=0.7760);内镜组术后并发症发生率低于显微镜组(5.71%vs.13.29%),差异有统计学意义(P=0.0470)。内镜组术后住院时间较显微镜组短[(6.12±1.94)d vs.(7.13±1.57)d],差异有统计学意义(P=0.0166)。结论:神经内镜手术在肿瘤全切方面与显微镜组相当,但术后并发症发生率及术后住院时间具有明显优势,代表了经鼻蝶垂体腺瘤手术的发展方向。

Objective：To comparatively analyze the clinical effect of trans-nasal-sphenoidal pituitary adenoma resection under neuroendoscope or microscope. Methods：Retrospective analysis was made on the clinical data of 263 patients with pituitary adenoma who underwent neuroendoscopie or microscopic trans-nasal-sphenoidal operation from Dec. 2009 to Dec. 2012. The differences in operation duration,volume of blood loss, total-resection rates, postoperative complication rates and mean postoperative hospital stay between 2 groups were compared. Results ： The mean operation duration time were （78.7 ± 34.55 ） min and （66.8 ± 31.32 ） min in endoscopic and microscopic group respectively,longer operation time was needed in endoscopic group, the difference was significant（P = 0. 014）. The blood-lost volume was （ 60.6 ± 32.35 ） ml and （ 55.1 ± 24.63 ） ml in endoscopic and microscopic group respectively with no significant differences between these two groups（P = 0. 943）. The total-resection rate of these two groups was 93.3% （98/105） and 92.4% （146/158） respectively ,with no significant differences （P = O. 7760）. The postoperative complication occurring rate in endoscopic group （ 5.71% ） was lower compared with microscopic group （ 13.29 % ） , which had a significant difference （ P = 0.0470 ）. The postoperative hospital stay was （6.12 ± 1.94） d and （7.13 ± 1.57） d respectively in endoscopic and microscopic group,with significant difference between these groups （P = 0. 0166 ）. Conclusions：Although being similar in total resection rates between endoscopic and microscopic operation, neuroendoscopie operation is superior in postoperative complication occurring rates and postoperative hospital stays,which may represent the trends of tans-nasal-sphenoidal pituitary adenoma resection.