前颅底及鞍区病变不同手术入路的治疗效果

Efficacy of different surgical approaches on anterior skull base and saddle area lesions

目的：分析不同入路手术治疗前颅底、鞍区病变的临床效果。方法随机选取2012年1月至2015年1月前颅底、鞍区病变患者71例，其中经眉弓入路手术38例为观察组，经额入路手术33例为对照组。比较两组肿瘤切除程度、手术时间、术后并发症、临床症状及生活质量。结果肿瘤切除程度、临床症状（头痛、视力障碍、内分泌症状）改善方面，观察组与对照组比较差异未见统计学意义（P ＞0.05）。观察组手术时间、术中出血量、术后并发症发生率分别为（180.4±18.8）min、（174.7±58.3）ml、5.3％，均低于对照组[（240.3±32.1）min、（265.7±83.2）ml、21.21％]，差异有统计学意义（P ＜0.05）。与术前比较，两组末次随访生活质量评分均明显增高（P ＜0.05），但两组比较差异未见统计学意义（P ＞0.05）。结论经眉弓入路、经额入路手术均能明显改善前颅底、鞍区病变患者临床症状及生活质量，但经眉弓入路手术时间及住院时间短，术中出血量少，术后并发症少。

Objective To analyze the effect of different surgical approaches on anterior skull base and saddle area lesions. Methods Seventy-one patients with anterior skull base and saddle area lesions who were randomly selected between January 2012 and January 2015,of them,38 cases underwent trans-eyebrow approach surgery were selected as observation group,and 33 cases underwent trans-forehead approach surgery were selected as control group. The degree of tumor resection,surgical time,postoperative complications and the relief of clinical symptoms and improvement of quality of life were compared between the two groups. Results There was no significant differences in the degree of tumor resection or clinical symptoms（headache,visual impairment,endocrine symptoms）between the two groups（P 〉 0. 05）. The differences in surgical time,intraoperative blood loss and incidence of post-operative complications between observation group[（180. 4 ± 18. 8）min,（174. 7 ± 58. 3）ml,5. 3% ] and control group[（240. 3 ± 32. 1）min,（265. 73 ± 83. 24）ml,21. 2% ]were significant（ P 〈0. 05）. At the end of follow-up,the scores of general health,physical pain,mental health,physiological function,physiological function,emotional function,social function and vitality in the two groups were higher than those before surgery（P 〉 0. 05）. Conclusions Both of trans-eyebrow and trans-forehead approach surgery can significantly relieve the clinical symptoms in patients with anterior skull base and saddle area lesions and improve quality of life. However,the surgical time and hospitalization time of the former is shorter,with less intraoperative blood loss and fewer postoperative complications.