经蝶窦入路手术切除垂体瘤的疗效分析

Effect analysis of nostril transsphenoidal approach in removal of pituitary adenomas

目的探讨经蝶窦入路手术与传统开颅手术切除垂体瘤的临床疗效。方法 105例垂体瘤患者按照手术方式的不同分为观察组54例和对照组51例。观察组采用经蝶窦入路垂体瘤切除术,对照组采用传统开颅手术。观察2组手术时间、术中出血量、下床时间、住院时间和肿瘤全切率,综合疗效,术后空腹血糖水平、汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)评分、数字分级法(NRS)疼痛程度评分,及术后并发症情况。结果观察组肿瘤全切率高于对照组,差异有统计学意义(P<0.01);观察组手术时间、术中出血量、下床时间、住院时间均显著小于对照组,差异有统计学意义(P<0.01);观察组综合疗效为优的比例高于对照组,优良率亦高于对照组,差异有统计学意义(P<0.05);观察组鼻腔出血、电解质紊乱的发生率显著低于对照组,差异有统计学意义(P<0.05,P<0.01)。结论与传统开颅手术相比,经蝶窦入路手术切除垂体瘤具有创伤小、切除彻底、综合疗效好、术后应激反应程度低、并发症少的优势。

Objective To investigate the clinical effect of nostril transsphenoidal approach in removal of pituitary adenomas. Methods A total of 105 patients with pituitary adenomas were divided into observation group（ n = 54） and control group（ n = 51） according to different surgical procedures.The observation group was treated with removal of pituitary adenomas through nostril transsphenoidal and the control group was treated with craniotomy. Operation time,blood loss,time to get out of bed,length of stay,total resection rate,comprehensive therapeutic effect,postoperative fasting plasma glucose,Hamilton depression scale（ HAMD）,Hamilton anxiety scale（ HAMA）,numerical pain rating scale（ NRS） and complications were compared between two groups. Results Compared with the control group,the observation group achieved a higher total resection rate（ P〈0. 01）,shorter operation time, less blood loss, shorter time to get out of bed and length of stay（ P 0. 0 1）,so was the superior rate of comprehensive therapeutic effect（ P〈0. 05）. The incidence rate of complications such as epistaxis and electrolyte disturbance was lower in the observation group than that in the control group（ P〈0. 05 or P〈0. 01）. Conclusion Nostril transsphenoidal approach in removal of pituitary adenomas shows a lot of advantages such as less trauma,better removal and comprehensive effect. It also shows benefits in reducing postoperative stress reaction and risk of complications.