神经内镜和显微镜下经鼻蝶垂体生长激素瘤切除的疗效分析

Clinical effect of neuroendoscopic and microscopic resection of growth hormone-secreting pituitary adenoma utilizing endonasal transsphenoidal approach

目的:比较神经内镜与显微镜经鼻蝶垂体生长激素(GH)瘤切除术的临床疗效。方法:取2014年6月至2020年1月广西医科大学附属民族医院收治的垂体生长激素瘤患者86例,分别采用神经内镜和显微镜进行手术,并根据手术方式不同分为内镜手术组(N组)45例和显微镜手术组(M组)41例。观察两组手术时间、术中出血量、住院时间、并发症、肿瘤全切率、肿瘤复发率、激素改善情况。结果:两组患者均成功完成手术治疗。两组手术时间比较,差异无统计学意义(P>0.05),N组的术中出血量少于M组,住院时间短于M组,术后并发症发生率、肿瘤复发率均低于M组(均P<0.05),激素下降水平、肿瘤全切率均高于M组(均P<0.05)。结论:神经内镜与显微镜均能治疗垂体GH瘤,但神经内镜下经鼻蝶手术切除垂体GH瘤能减少术中出血,缩短患者住院时间,提高肿瘤全切率,利于激素改善,减少术后并发症的发生率及肿瘤的复发率,临床上有良好的应用前景。

Objective:To compare the clinical efficacy of neuroendoscopic and microscopic resection of growth hormone-secreting pituitary adenoma via endonasal transsphenoidal approach. Methods: A total of 86 patients of growth hormone-secreting pituitary adenoma admitted to The Affiliated Minzu Hospital of Guangxi Medical University from June 2014 to January 2020 were selected. They were operated using neuroendoscope and microscope. According to different surgical methods,the patients were divided into the neuroendoscopic surgery group(N group) of 45 cases and the microscopic surgery group(M group) of 41 cases. Operation time, intraoperative blood loss, hospitalization time, complications, tumor total resection rate, tumor recurrence rate, hormone improvement in the two groups were observed.Results: Surgical treatment was completed in both groups successfully. There was no significant difference in operation time between the two groups(P>0.05). The amount of intraoperative blood loss, incidence of postoperative complications, hospitalization time and tumor recurrence rate ofN group were lower than those of M group, with statistical significance(P<0.05). The decrease of hormone and tumor resection rate of N group were higher than those in M group, with statistical significance(P<0.05).Conclusion: Growth hormone-secreting pituitary adenoma can be cured by both neuroendoscopy and microscopy surgery, however, neuroendoscopy for transsphenoidal resection of pituitary adenoma can reduce intraoperative bleeding, shorten hospitalization time, increase tumor total resection rate, improve hormone levels, and reduce the incidence of postoperative complications and recurrence of the pituitary adenoma, which has good application prospect in clinic.