神经内镜与显微镜经单鼻孔蝶窦入路切除垂体腺瘤疗效比较

Comparison of curative effect of resection of pituitary adenoma by endoscope and microscope single nostril transsphenoidal approach

目的比较神经内镜与显微镜下经单鼻孔蝶窦入路切除垂体腺瘤的疗效。方法回顾性分析2007年7月至2008年7月40例神经内镜下(神经内镜组)和24例显微镜下(显微镜组)经鼻蝶窦入路垂体瘤切除患者的临床资料,对比两组患者手术疗效。计量资料采用t检验或秩和检验,计数资料采用χ2检验或秩和检验。结果神经内镜组肿瘤全切率为92.5%,显微镜组全切除率为83.3%,两组差异不具有统计学意义(χ2=0.524,P=0.469)。神经内镜组手术时间2.1(0.50)h,显微镜组2.6(1.15)h,两组差异不具有统计学意义(Z=-1.848,P=0.065);术中出血量[20.0(5.00)ml]少于显微镜组[25.5(12.25)ml,Z=-3.757,P=0.000];住院时间[(8.75±2.753)d]显著短于显微镜组[(15.13±3.069)d,t=-8.591,P=0.000]。神经内镜组发生尿崩2例、电解质紊乱4例,显微镜组发生尿崩2例、脑脊液漏2例、高热1例、电解质紊乱4例、鼻中隔缺损6例,除鼻中隔缺损(χ2=8.288,P=0.004)差异有统计学意义外,其他并发症发生率差异无统计学意义(P均>0.05)。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,安全性高。其中内镜治疗在术中出血量、住院时间、并发症方面更具优势,是今后神经外科手术的发展方向。

Objective To compare the curative effect of resection of pituitary adenoma by endoscope and microscope single nostril transsphenoidal approach.Me thods From July 2007 to July 2008 ,40 cases of endoscopic （ endoscopic group ） and 24 cases of microscope （ microscopy group ） by transsphenoidal removal of pituitary adenomas patients with clinical data were retrospectively analyzed ,the operation curative effect were compared.t test, rank sum test or χ2 were used to compare the differences between the two groups . Results Total resection rate in endoscopic group was 92.5%,while in microscopy group total was 83.3%, there was no statistical difference between the two groups （χ2 =0.524 , P =0.469 ） .Operation time in endoscopy group was 2.1 （ 0.50 ） h, while in microscopy group was 2.6 （ 1.15 ） h, there was no statistical difference between the two groups （Z=-1.848,P=0.065）.The amount of bleeding in endoscopy group [20.0（5.00）ml]was less than that in microscopy group [25.5（12.25）ml,Z=-3.757,P=0.000];Hospitalization time in endoscopy group [（8.75 ±2.753） d] was significantly shorter than the microscope group [（15.13 ±3.069）d,t =-8.591,P=0.000].In endoscopic group,there were 2 cases of diabetes insipidus,electrolyte disorder in 4 cases,in microscopy group,there were 2 cases of diabetes insipidus, leakage of cerebrospinal fluid in 2 cases,fever in 1 cases,electrolyte disorders in 4 cases,nasal septal defect in 6 cases.Except the nasal septum defect had significant difference between the two groups （χ2 =8.288,P=0.004 ） ,there was no significant difference in other complication rates （ P〉0.05 ） .Conclusion Endoscope and microscope place an order nostril transsphenoidal approach for pituitary adenoma resection with curative effect and safety.The endoscopic treatment for bleeding , hospitalization time, complications have more advantages ,and it will be the development direction operation of the neurosurgery in the future .