神经内镜联合神经导航手术治疗侵袭性垂体瘤的疗效观察

The effect of neuronavigator and endoscopic guidance for patients with invasive pituitary tumors

目的探讨神经内镜联合神经导航手术治疗侵袭性垂体瘤的临床疗效。方法收集2008年1月~2011年12月该院收治的经鼻蝶入路手术切除侵袭性垂体腺瘤患者132例,按不同手术方式分成：研究组（75例）和对照组（57例）,研究组采用神经内镜联合神经导航手术治疗,对照组采用常规经鼻蝶垂体瘤切除术。观察比较两组手术相关指标、手术切除范围和术后症状缓解情况、术前术后血清内分泌学变化及术后随访残留和复发情况。结果研究组的手术时间（86.9±9.6）min和住院时间（6.5±0.5）min明显短于对照组（142.8±10.2）及（12.9±0.8）min,而研究组患者术中出血量（121.7±17.3）mL、术后一过性尿崩（8.0%）和术后短暂性电解质紊乱（10.7%）发生率也明显少于对照组（[208.5±21.8）mL,31.6%,35.1%],差异有显著性（P〈0.05）。研究组患者手术有效切除率（82.7%）和术后症状缓解率（89.3%）明显高于对照组（40.4%,56.1%）,而术后随访发现,残留（5例）和复发病例（4例）明显少于对照组（11例,16例）,差异有显著性（P〈0.05）。两组不同性质肿瘤的术前、术后血清内分泌学检测情况比较,两组PRL腺瘤术后血清PRL（[42.6±21.4）,（148.5±67.4）]ng/mL、GH腺瘤术后血清GH（[10.6±2.4）,（32.4±11.6）]ng/mL、ACTH腺瘤术后血清ACTH（[38.5±4.6）,（83.6±32.5）]ng/L水平均较术前明显下降（P〈0.05）,而研究组下降程度明显高于对照组（P〈0.05）。结论神经内镜联合神经导航手术治疗侵袭性垂体瘤,能提高手术全切率,有效控制患者复发,安全性好,是侵袭性垂体瘤手术治疗的较佳手术方案。

【Objective】To explore the effect of neuronavigator combined endoscopic guidance on patients with invasive pituitary tumors.【Methods】132 patients with invasive pituitary tumors from January 2008 to December 2012 were treated by surgical treatment under neuronavigator and endoscopic guidance.132 patients were divided into two groups：study group（75 cases） and control group（57 cases）.The surgery index,the surgical extent,the re mission of symptoms after operation,the changes of serum endocrinology and recurrence after operation in two groups were compared.【Results】The time of operation（86.9±9.6） min and hospital stays（6.5±0.5） min in study group were significantly shorter than those in control group [（142.8 ±10.2）,（12.9±0.8）] min（P 0.05）.The haemorrhage of operation（121.7±17.3） mL,the rates of transient diabetes insipidus（8.0%） and electrolyte disturbances（10.7%） in study group were significantly less than those in control group [（208.5±21.8） mL,31.6%,35.1%]（P 0.05）.The excision rate（82.7%） and remission rate（89.3%） in study group were significantly higher than those in control group（40.4%,56.1%）（P 0.05）.The residual（5 cases） and recurrence（4 cases） after operation in study group were significantly less than that in control group（11 cases,16 cases）（P 0.05）.The levels of GH [（10.6±2.4）,（32.4±11.6）] ng/mL of GH pituitary tumor,PRL [（42.6±21.4）,（148.5±67.4）] ng/mL of PRL pituitary tumor,ACTH [（38.5±4.6）,（83.6±32.5）] ng/L of ACTH pituitary tumor decreased significantly in two groups（P 0.05） and the decreasing degree in study group was higher than that in control group（P 0.05）.【Conclusion】Surgical treatment under neuronavigator and endoscopic guidance is helpful to improve the total removal rate and to control the recurrence after operation.It＇s a safe and better operation for invasive pituitary tumors.