神经内镜与显微镜在单鼻孔蝶窦入路切除垂体瘤患者中的疗效及并发症观察

Observation of the efficacy and complications of neuroendoscopy and microscope in the treatment of pituitary adenoma with single nostril transsphenoidal approach

目的对比神经内镜和显微镜在单鼻孔蝶窦入路切除垂体腺瘤的临床疗效及并发症情况。方法对2012-03—2016-02于川北医学院附属医院及暨南大学附一院住院的92例经鼻蝶窦入路垂体瘤切除患者进行前瞻性研究,显微镜组和神经内镜组各46例,对2组患者临床资料、治疗、预后情况以及术后6个月激素水平的恢复情况进行分析。结果神经内镜组手术时间(85.2±12.7)min,住院时间(6.1±1.1)d,术后并发症发生率8.69%,低于显微镜组的(122.5±23.4)min、(9.3±2.2)d、及23.91%,差异均有统计学意义(P<0.05)。神经内镜组术中出血量(51.4±4.8)mL,肿瘤全切率84.78%,显微镜组分别为(75.2±6.7)mL、80.43%,差异无统计学意义(P>0.05)。神经内镜组术后6个月复查激素水平恢复正常20例,激素水平改善10例,激素水平改善率83.33%;显微镜组激素水平恢复正常18例,激素水平改善9例,激素水平改善率81.82%,组间比较差异无统计学意义(P=0.868)。结论与显微镜手术比较,采用神经内镜下单鼻孔经蝶入路垂体瘤切除术具有手术时间短、住院时间少、术后恢复好等优势,适宜临床推广应用。

Objective To compare the clinical efficacy and complications of pituitary adenomas with single nostril transsphenoidal approach for the removal by neuroendoscopy and microscopy.Methods Ninety-two patients with pituitary adenomas by transnasal transsphenoidal approach were enrolled in the Affiliated Hospital of North Sichuan Medical College and the First Affiliated Hospieal of Ji＇nan University from March 2012 to February 2016,and were prospectively stydied.Forty-six patients in the microscope group and neuroendoscopy group.Clinical data,treatment,prognosis and hormone levels after six months of recovery were analyzed.Results In the neuroendoscopy group,the operation time was（85.2±12.7）min,the hospitalization time was（6.1±1.1）days,the complication rate was 8.69%,which was lower than the microscope group of（122.5±23.4）min,（9.3±2.2）days and 23.91%,respectively.In the neuroendoscopy group,the intraoperative blood loss was（51.4±4.8）mL,the total resection rate of tumor was 84.78%,which was higher than（75.2±6.7）mL and 80.43%in the microscope group,respectively.In the neuroendoscopy group,the hormone level returned to normal in 20 cases,declined in 10 cases,and the improvement rate of hormone level was 83.33%;the level of hormone in microscope group returned to normal in 18 cases,declined in 9cases,and the improvement rate was 81.82%.There was no significant difference between the two groups（P=0.868）.Conclusion Compared with microscope operation,neuroendoscopic single nostril transsphenoidal pituitary tumor resection has the advantages of short operation time,short hospital stay and lower postoperative complications.The neuroendoscopy surgery can be popularized clinically.