神经内镜与显微镜下经鼻蝶垂体瘤切除术的对比

Comparative study of enodonasal endoscopic surgery vs.microsurgery for pituitary adenoma

目的 探讨神经内镜与显微镜手术经鼻蝶治疗垂体瘤的效果.方法 遵循随机对照的实验原则,将垂体瘤患者随机分为两组,神经内镜下经鼻蝶治疗垂体瘤40例,同期显微镜下经鼻蝶治疗垂体瘤40例,通过统计分析患者术前一般资料、临床症状、术前影像学检查及内分泌学检查,术中出血量,术中是否出现脑脊液漏,术后住院时间,肿瘤切除情况,症状缓解情况,激素恢复情况及并发症,比较两种术式的手术效果.结果 两组手术均获成功,内镜组和显微镜组术中出血量分别为（48.6±6.0）和（78.4±13.0）ml、术后住院时分别为（5.3±0.8）和（9.1±0.5）d、术中是否出现脑脊液漏内镜组优于显微镜组,且差异有统计学意义（x^2=13.131,P＜0.05）;在术前症状是否缓解（x^2 =4.310,P＞0.05）、肿瘤是否全切除（x^2=5.322,P＞0.05）及术后激素恢复情况（x2=8.342,P＞0.05）的比较中,内镜组与显微镜组效果相当,差异均无统计学意义;在术后并发症发生率的对比分析中,内镜组并发症发生率明显小于显微镜组,且差异有统计学意义（x^2=3.675,P＜0.05）.结论 神经内镜下经鼻蝶垂体瘤切除术是一种创伤小、操作简便、治疗效果好、并发症相对较少的神经外科技术.

Objective To study the enodonasal endoscopic surgery and microsurgery for the treatment of pituitary adenoma.Methods Following the randomized controlled experiment method,the patients were randomly divided into two groups.Forty cases of pituitary adenoma underwent the endoscopic enodonasal transsphenoidal surgery,and in the same period,40 cases of pituitary adenoma underwent the microscopic enodonasal transsphenoidal surgery.The physical data,clinical manifestation,imaging examination,endocrine examination before surgery,bleeding vomume and CSF leak during the surgery,and the postoperative hospital stay,tumor total removal,the relief of clinical symptom,the recovery of hormone and complications were compared between two procedures.Results Endoscopic group was more excellent than microscopy group in bleeding volume,The former is （48.6 ± 6.0） ml and the latter is （78.4 ± 13.0） ml,CSF leak or not during the surgery （x2 =13.131,P 〈 0.05）,and in hospital stadys after operation,The former is （5.3 ± 0.8） d and the latter is （9.1 ± 0.5） d,the difference was statistically singificant P 〈 0.05.The effect of two groups were similar in tumor total removal or not （x^2 =5.322,P 〉 0.05）,the relief of clinical symptom （x^2 =4.310,P 〉 0.05）,the recovery of hormone after operation （x^2 =8.342,P 〉0.05）,and the difference was not statistically significant.The complications after operation of Endoscopic group were much less than microscopy （x^2 =3.675,P 〈 0.05）,and the difference was statistically singificant.Conclusion The endoscopic endonasal transsphenoidal surgery is a safe and effective procedure.