导航辅助内镜下经鼻蝶窦垂体瘤切除术治疗垂体瘤的疗效及预后研究

Study on the efficacy of navigation-assisted endoscopic endonasal transsphenoidal pituitary adenoma resection in the treatment of pituitary adenomas and the prognosis

目的探究导航辅助内镜下经鼻蝶窦垂体瘤切除术治疗垂体瘤的疗效。方法选取2017年9月—2019年9月本院收治的86例垂体瘤患者作为研究对象,采用随机数表法分为观察组和对照组两组,每组各43例。观察组行导航辅助内镜下经鼻蝶窦垂体瘤切除术,对照组行经鼻前庭入路手术治疗。比较两组患者的手术及症状改善情况、激素水平、鼻腔嗅觉功能和预后质量。结果两组患者的手术时间、术后住院时间、垂体瘤完全切除率、视野改善率和垂体功能改善率比较,无显著差异(P>0.05);观察组的术中出血量小于对照组,差异有统计学意义(P<0.05)。手术后,两组患者的促肾上腺皮质激素(ACTH)、生长激素(GH)和泌乳素(PRL)水平均降低,且观察组的ACTH、GH和PRL水平低于对照组,差异均有统计学意义(P<0.05)。手术后1个月,观察组的嗅觉识别阈水平、SF-36评分均高于对照组,差异均有统计学意义(P<0.05);两组患者的嗅觉异常率比较,无显著差异(P>0.05)。两组患者均出现尿崩症、电解质紊乱、脑脊液漏和鼻中隔穿孔等术后并发症,观察组的术后并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论导航辅助内镜下经鼻蝶窦垂体瘤切除术能有效地减少患者术中出血量,改善患者的嗅觉识别阈水平,降低术后并发症发生率,提高预后质量。

Objective To explore the efficacy of navigation-assisted endoscopic endonasal transsphenoidal pituitary adenoma resection in the treatment of pituitary adenomas.Methods A total of 86 patients with pituitary adenomas those treated in the hospital between September 2017 and September 2019 were selected as the subjects.They were divided into the observation group(n=43)and the control group(n=43)by random number table method.The observation group was treated with navigation-assisted endoscopic endonasal transsphenoidal pituitary adenoma resection,and the control group was treated with transnasal vestibular sphenoid sinus surgery.The situation of surgery,symptom improvement,hormone levels,nasal olfactory function and prognostic quality were compared between the two groups.Results There were no significant differences in the operation time,postoperative hospital stay,complete resection rate of pituitary adenoma,improvement rate of visual field and improvement rate of pituitary function between the two groups(P>0.05).The amount of intraoperative blood loss of the observation group was less than that of the control group(P<0.05).After surgery,the levels of adrenocorticotropic hormone(ACTH),growth hormone(GH)and prolactin(PRL)in the two groups decreased,and the levels in the observation group were lower than the control group(P<0.05).The olfactory recognition threshold and SF-36 score of the observation group at 1 month after surgery were higher than those of the control group(P<0.05).There was no significant difference in olfactory abnormality rate between the two groups(P>0.05).Postoperative complications such as diabetes insipidus,electrolyte disturbance,cerebrospinal fluid leakage and nasal septum perforation occurred in both two groups.The incidence rate of postoperative complications in the observation group was lower than that in the control group(P<0.05).Conclusions Navigation-assisted endoscopic endonasal transsphenoidal pituitary adenoma resection could effectively reduce the intraoperative blood loss,improve the olfactory recognition threshold,reduce the incidence of postoperative complications,and improve the prognostic quality of patients.