内镜与显微镜下手术切除垂体瘤的疗效

Clinical effects of microscopic and endoscopic approach on the resection of pituitary adenomas

目的:探讨内镜与显微镜下经蝶入路手术切除垂体瘤的临床疗效,总结各自优缺点。方法:回顾性分析2014年9月至2016年8月间收治的96例经鼻蝶入路手术切除垂体瘤的患者,50例患者行内镜下经鼻蝶入路垂体瘤切除术(内镜组),46例患者行显微镜下经鼻蝶入路垂体瘤切除术(显微镜组),比较两者患者手术效果。结果:内镜组与显微镜组患者在肿瘤切除率、术后并发症发生率、症状缓解率方面比较,差异无统计学意义(P>0.05);内镜组患者在术中出血量和术中脑脊液漏率低于显微镜组(P<0.05);内镜组患者手术时间(86.3±10.4)h、术后住院天数(6.1±0.9)d,短于显微镜组患者的(137.7±16.2)h和(12.3±1.2)d(P<0.05)。结论:内镜下经鼻蝶手术和显微镜下经鼻蝶手术都可以较好地切除肿瘤,内镜下经鼻蝶手术创伤较小,术后恢复快,值得推广,但显微镜手术不能被完全替代,应根据不同适应证选择合适术式。

Objective： To discuss the clinical efficacy of endonosal transsphenoidal surgery under endoscope and microscope on the removal of pituitary adenomas and to summarize their advantages and disadvantages. Methods： 96 cases of patients with pituitary adenoma treated by endonasal transsphenoidal surgery from September 2014 to August 2016 were retrospectively analyzed,and divided into endoscope group（ under endoscope,50 cases） and microscope group（ under microscope,46 cases）. The operation results were compared between the two groups. Results： There were no statistic differences in tumor resection rate,postoperative complication rate,and symptom relief between the two groups（ P 〉 0. 05）. The intraoperative bleeding and intraoperative cerebrospinal fluid leakage in the endoscope group were lower than those in the microscope group（ P 〈 0.05）; the operation time（ 86. 3 ± 10. 4） h and hospitalization time（ 6. 1 ± 0. 9） d in the endoscope group were less than those in the microscope group（ 137. 7 ± 16. 2） h,（ 12. 3 ± 1. 2） d）（ P 〈 0. 05）. Conclusion： The endonosal transsphenoidal surgery under endoscope and microscope can remove the tumor sufficiently. Endoscopic transsphenoidal surgery,with less suffering,faster recovery,should be widely spread,but microscopic surgery can not be completely replaced and the appropriate type of surgery should be selected based on different indications.