内镜与显微镜经鼻腔蝶窦入路切除垂体腺瘤疗效比较的前瞻性研究

Comparison of endoscopic and microscopic transsphenoidal pituitary surgery

目的 探讨神经内镜经鼻腔蝶窦和显微镜经鼻腔蝶窦手术在治疗垂体腺瘤疗效等方面的差别.方法 入组2010年10月至2011年10月,经鼻腔蝶窦入路治疗的垂体腺瘤患者862例,其中内镜组226例,显微镜组636例,观察、分析肿瘤切除程度、视力视野改善情况、手术时间和住院日.结果 在微腺瘤和巨大腺瘤组,两种手术方式切除程度差异无统计学意义（P＞0.05）;在大腺瘤组,内镜组优于显微镜组（P＜0.05）.依据Knosp分级比较,内镜组和显微镜组切除程度构成比在Knosp0 ～2级和4级差异无统计学意义,在Knosp 3级差异有统计学意义,内镜组切除较好（P＜0.05）.视力视野改善情况内镜组优于显微镜组（P＜0.05）.内镜组手术时间和住院日较显微镜组短（P＜0.05）.结论 内镜经鼻腔蝶窦入路垂体腺瘤切除术手术时间和住院时间较显微镜经鼻腔蝶窦具有优势.虽然在微腺瘤和巨大腺瘤切除构成比上内镜和显微镜无明显差异,但内镜在切除Knosp 3级侵袭性腺瘤上具有优势。

Objective To analyze the outcomes of neuro endoscopic and microscopic pituitary adenoma surgery.Methods A total of 862 cases were enrolled in between October 2010 and October 2011,including 226 cases in endoscopic group and 636 in microscopic group.The extent of tumor resection,visual improvement,operation time and hospitalization days were compared between two groups.Results There was no statistical difference in the extent of tumor resection in microadenomas and giant pituitary adenomas between two groups.While endoscopic surgery resulted in superior resection in macroadenomas.Analyzed by Knosp grading,according to the removal rates,there was no significant difference showed at Knosp level 0-2 and level 4,while endoscopic surgery resulted in superior resection at level 3 （P 〈 0.05）.The visual acuity and visual field were better in the endoscopic group.The operation time and length of stay in hospitals were both shorter in the endoscopic group than those in the microscopic group.Conclusions Endoscopic transsphenoidal resection of pituitary tumors was safe,with shorter operation time and length of stay.Endoscopic and microscopic transsphenoidal operations had their own advantages,and the advantage of endoscopic transsphenoidal surgery lied in the treatment of invasive adenoma of Knosp 3 grade.