神经内镜下单鼻孔经蝶窦入路手术治疗垂体瘤的临床分析

Single nostril transsphenoidal approach in treatment of pituitary adenoma under neuroendoscopy：a clinical analysis

目的：探讨神经内镜下单鼻孔经蝶窦入路手术治疗垂体瘤的疗效。方法收集2012年9月至2015年9月于本科室就诊的垂体瘤患者120例，按随机数字表分为蝶窦组和常规治疗组，每组60例。常规治疗组患者给予常规经颅切除手术治疗，蝶窦组患者给予神经内镜下单鼻孔经蝶窦入路切除手术治疗。术前和术后3个月采用酶联免疫吸附法检查两组患者血清催乳素（PRL）、生长激素（GH）、促肾上腺皮质激素（ACTH）水平。记录患者的手术时间、术中出血量、下床时间、住院时间和术后并发症发生情况。结果蝶窦组患者手术时间、术中出血量、下床时间和住院时间均显著低于常规治疗组（均P〈0.05）。两组患者术后血清PRL、GH、ACTH水平较术前均显著下降（均P〈0.05）；术前、术后3个月两组患者血清PRL、GH、ACTH水平组间比较，差异均无统计学意义（均P〉0.05）。蝶窦组和常规治疗组术后并发症发生率分别为8.3%（5/60）和21.7%（13/60），蝶窦组患者术后并发症发生率显著低于常规治疗组（χ2=4.183，P〈0.05）。结论神经内镜下单鼻孔经蝶窦入路手术治疗垂体瘤疗效较好，可有效减少术后并发症并改善垂体功能。

Objective To investigate the efficacy of single nostril transsphenoidal approach in treatment of pituitary adenoma under neuroendoscopy. Methods A total of 120 patients with pituitary adenoma,who were hospitalized in our department between September 2012 to September 2015,were included in the study,and randomly divided into the sphenoid sinus group and the conventional treatment group （n=60 each）. The conventional treatment group received conventional transcranial resection. The sphenoid sinus group was given resection via single nostril transsphenoidal approach under neuroendoscopy. Before and at 3 months after the operation,enzyme？linked immunosorbent assay was used to examine the levels of serum prolactin（PRL）,growth hormone（GH）,and adrenocorticotropic hormone（ACTH）in the two groups. The operation time,intraoperative blood loss,time to ambulation,length of hospital stay,and postoperative complications were recorded. Results The operation time,intraoperative blood loss,time to ambulation,and length of hospital stay in the sphenoid sinus group were significantly less than those in the conventional treatment group（all P〈0.05）. The postoperative levels of serum PRL,GH and ACTH in the two groups were significantly lower than those at the baseline（all P〈0.05）. Before and at 3 months after the treatment,there was no statistically significant difference in the levels of serum PRL,GH and ACTH between the two groups（all P〉0.05）. The incidence of postoperative complications in the sphenoid sinus group and conventional treatment group was 8.3%（5/60）and 21.7%（13/60）,respectively. The incidence of postoperative complications in the sphenoid sinus group was significantly lower than that in the conventionaltreatment group（χ2=4.183,P〈0.05）. Conclusion Single nostril transsphenoidal approach in the treatment of pituitary adenoma under neuroendoscopy is effective, which can effectively reduce postoperative complications and improve pituitary function.