内镜与显微镜下经鼻蝶窦手术治疗垂体瘤的效果及对患者激素水平及视觉功能的影响

Effect of Endoscopic and Microscopic Transsphenoidal Surgery on Serum Hormone Levels and Visual Function in Patients with Pituitary Adenomas

目的对比神经内镜与显微镜经鼻蝶窦手术治疗垂体瘤的疗效及对患者激素水平及视觉功能的影响。方法对行内镜或显微镜经鼻蝶窦手术治疗的78例垂体瘤患者进行回顾性分析,根据手术方式不同分为内镜组(n=40)和显微镜组(n=38)。比较2组手术一般情况、术后并发症、术后激素变化、视觉功能改善及随访6个月时主要症状缓解情况。结果内镜组肿瘤完全切除率(92.50%)明显高于显微镜组(73.7%),术后并发症发生率明显低于显微镜组,差异均有统计学意义(P<0.05)。内镜组术后泌乳素(PRL)、生长激素(GH)、促甲状腺素(TSH)明显低于显微镜组(P<0.05),2组促肾上腺皮质激素(ACTH)比较无统计学差异(P>0.05)。内镜组术后视野指标加权视野指数(VFII)显著高于显微镜组(P<0.05),视野平均缺损(MD)、模式标准差(PSD)明显低于显微镜组(P<0.05)。术后6个月时,2组头痛、月经紊乱、视力视野改变、性功能减退等缓解率比较无统计学差异(P>0.05)。结论内镜下经鼻蝶窦垂体瘤切除术相比于显微镜手术,具有全切率高、并发症少等优势,且在改善术后激素水平及视觉功能上效果更显著,是较为理想的垂体瘤手术术式。

Objective To compare the effect of neuroendoscopic and microscopic transsphenoidal surgery in the treatment of pituitary adenomas and the effect on serum hormone levels.Methods A retrospective analysis was conducted.78 patients with pituitary adenomas who underwent endoscopic or microscopic transsphenoidal surgery were enrolled in the research.They were divided into the endoscopic group(n=40)and the microscopic group(n=38)according to the surgical method.General conditions of surgery,postoperative complications,changes of hormones,improvement of visual function and remission of major symptoms during 6 months of follow-up were compared between the 2 groups.Results The total resection rate of the endoscopic group(92.50%)was significantly higher than that of the microscopic group(73.7%).The incidence of postoperative complications was significantly lower than that in the microscopic group(P<0.05).Levels of prolactin(PRL),growth hormone(GH)and thyroid stimulating hormone(TSH)in the endoscopic group were significantly lower than those in the microscopic group after surgery(P<0.05).There was no significant difference in the level of adrenocorticotropic hormone(ACTH)between the two groups(P>0.05).The weighted visual field index(VFII)of the endoscopic group was significantly higher than that in the microscopic group after surgery(P<0.05),while the meandefect(MD)of visual field and pattern standard deviation(PSD)were significantly lower than those of the microscopic group(P<0.05).There was no significant difference in the remission rate of headache,menstrual disorders,changes of visual acuity and visual field or sexual dysfunction between the two groups at 6 months after surgery(P>0.05).Conclusion Endoscopic transsphenoidal resection of pituitary adenomas has advantages of high total resection rate,fewer complications,compared with microscopic surgery.It is more effective in improving postoperative hormone levels and visual function.It is an ideal surgical procedure for pituitary adenomas.