经鼻蝶神经内镜与显微镜下切除垂体瘤的安全性与疗效对比

Comparison of safety and efficacy of transsphenoidal neuroendoscopic and microscopical resection of pituitary tumors

目的比较经鼻蝶神经内镜与显微镜下切除垂体瘤的安全性和疗效。方法回顾性分析我院自2019年7月至2021年8月垂体瘤患者391例,其中神经内镜组212例,显微镜组179例,对比两组患者的手术时间、术中出血量、住院时间、肿瘤全切率、术中脑脊液漏的发生率、术后并发症的发生情况、术后视力视野的改善情况以及相关的围手术期指标。结果同显微镜组相比,神经内镜组患者手术时间明显较长(129.66±49.66mins vs.76.87±19.23mins,P<0.001),两组患者总体肿瘤全切率无明显异常(70.8%vs.63.7%,P=0.137),但其中KnospⅢ-Ⅳ级的患者,神经内镜组的手术全切率有明显优势(67.1%vs.32.3%,P<0.001)。两组患者在术中出血量(67.33±19.95mL vs.62.21±15.45mL,P=0.082)、术后住院时间(4.65±1.31天vs.4.31±1.24天,P=0.237)、术中高流量脑脊液漏的发生率(4.7%vs.6.1%,P=0.533)、术中颈内动脉损伤情况(0.5%vs.0.6%,P=0.904)和术后垂体相关激素水平的恢复等指标上均无统计学差异。两组患者的术后并发症的发生率均很低,且两组患者之间无统计学差异,包括:术后脑脊液鼻漏(0.9%vs.1.6%,P=0.558)、颅内感染(0.9%vs.1.1%,P=0.865)、尿崩(4.2%vs.6.1%,P=0.533)、再出血(0.9%vs.1.1%,P=0.865)。两组患者术后的视力视野较术前均明显好转,但两组患者之间的好转率无显著差异(77.9%vs.85.7%,P=0.170)。结论经鼻蝶神经内镜与显微镜下切除垂体瘤均具有满意的安全性与疗效,对于KnospⅢ-Ⅳ级肿瘤侵犯海绵窦的患者,神经内镜手术更具优势。

Objective To compare the safety and efficacy of transsphenoidal neuroendoscopic and microscopical resection of pituitary tumors.Methods 391 cases of pituitary tumor in our hospital from July 2019 to August 2021 were retrospectively analyzed,including 212 cases in the neuroendoscopy group and 179 cases in the microscope group.Operation time,intraoperative blood loss,length of stay,the rate of total removal of tumor,incidence of intraoperative cerebrospinal fluid leakage,occurrence of postoperative complications,improvement of postoperative visual field and related perioperative indicators were compared between the two groups.Results Compared with the microscope group,the operation time of patients in the neuroendoscopy group was significantly longer(129.66±49.66 mins vs.76.87±19.23 mins,P<0.001),and the total tumor resection rate in the two groups was not significantly abnormal(70.8%vs.63.7%,P=0.137).However,for KnospⅢ-Ⅳpatients,the total surgical resection rate was significantly high-er in the neuroendoscopic group(67.1%vs.32.3%,P<0.001).Intraoperative blood loss(67.33±19.95 mL vs.62.21±15.45 mL,P=0.082),postoperative hospital stay(4.65±1.31 days vs.4.31±1.24 days,P=0.237),the incidence of intraoperative high-flow cerebrospinal fluid leakage(4.7%vs.6.1%,P=0.533),intraoperative internal carotid artery injury(0.5%vs.0.6%,P=0.904),and postoperative recovery of pituitary-related hormone levels were not significantly different.The incidence of postoperative complications was low in both groups,and there was no statistical difference between the two groups,including:Postoperative cerebrospinal fluid rhinorrhea(0.9%vs.1.6%,P=0.558),intracranial infection(0.9%vs.1.1%,P=0.865),diabetes insipidus(4.2%vs.6.1%,P=0.533),and rebleeding(0.9%vs.1.1%,P=0.865).Postoperative visual field was significantly improved in both groups,but there was no significant difference in the rate of improvement between the two groups(77.9%vs.85.7%,P=0.170).Conclusion Bothtranssphenoidalneuroendoscopic and microscopic resection of pituitary tumors have satisfactory safety and efficacy.For patients with KnospⅢ-Ⅳ,whose tumors invading the cavernous sinus,neuroendoscopic surgery is more advantageous.