神经导航辅助内镜经鼻蝶手术治疗侵袭性垂体腺瘤的疗效分析

Efficacy of neuronavigation-assisted endoscopic transsphenoidal surgery for invasive pituitary adenomas

目的探讨神经导航辅助内镜经鼻蝶手术治疗侵袭性垂体腺瘤的疗效。方法回顾性分析2010年1月至2018年3月大连医科大学附属大连市中心医院神经外科收治的40例侵袭性垂体腺瘤患者的临床资料,其中20例采用神经导航辅助内镜经鼻蝶手术治疗(内镜组),另20例采用传统经鼻蝶显微手术治疗(对照组)。对比两组患者的肿瘤完全切除率、术后并发症发生率及肿瘤复发率。结果两组患者的性别、年龄、临床表现、内分泌检查结果、垂体腺瘤Knosp分级及肿瘤最大径方面的差异均无统计学意义(均P>0.05)。内镜组患者肿瘤完全切除率高于对照组[分别为65.0%(13/20),20.0%(4/20),P<0.05],肿瘤复发率显著低于对照组[分别为15.0%(3/20)、50.0%(10/20),P<0.05],但是两组患者术后并发症发生率[分别为65.0%(13/20).85.0%(17/20)]的差异无统计学意义(P>0.05)。结论神经导航辅助内镜经鼻蝶手术治疗侵袭性垂体腺瘤较传统经鼻蝶显微手术的肿瘤完全切除率高、术后肿瘤复发率低。

Objective To explore the effect of neuronavigation-assisted endoscopic transsphenoidal surgery for invasive pituitary adenomas.Methods A retrospective analysis was conducted on 40 patients with invasive pituitary adenomas admitted to Department of Neurosurgery,Affiliated Dalian Municipal Central Hospital,Dalian Medical University from January 2010 to March 2018.Among those patients,20 were treated with neuronavigation-assisted endoscopic transnasal sphenoidal surgery(endoscopic group)and the other 20 were treated with traditional transnasal microsurgery(control group).The complete tumor resection rate,postoperative complication rate and tumor recurrence rate were compared between the 2 groups.Results There were no significant differences in gender,age,clinical manifestations,endocrine examination results,Knosp classification of pituitary adenomas or maximum diameter of tumors between the 2 groups(all P>0.05).The total resection rate of endoscopic group was higher than that in the control group[65.0%(13/20)vs.20.0%(4/20),P<0.05].The tumor recurrence rate in endoscopic group was significantly lower than that of the control group[15.0%(3/20)vs.50.0%(10/20),P<0.05].However,the incidence of postoperative complications in the 2 groups[65.0%(13/20)vs.85.0%(17/20),respectively]was not statistically significant(P>0.05).Conclusion Neuronavigation-assisted endoscopic transnasal sphenoidal surgery for invasive pituitary adenomas is associated with higher total resection rate and lower recurrence rate compared with traditional transnasal sphenoidal microsurgery.