神经内镜下2种入路途径联合垂体边界辨认技术对垂体腺瘤切除率及并发症影响

Effects of two neuroendoscopic approaches combined with pituitary boundary identification technique on the resection rate and complications of pituitary adenoma

目的探究神经内镜下不同入路联合垂体边界辨认技术在垂体腺瘤(PA)患者治疗中的应用价值。方法选取2018-09-01-2021-07-01睢县人民医院实施神经内镜联合垂体边界辨认技术的78例PA患者,按照入路方式分为单鼻孔组(n=39)和双鼻孔组(n=39)。比较2组治疗效果、手术指标、手术前后应激指标〔血管紧张素Ⅱ(AngⅡ)、去甲肾上腺素(NE)、肾上腺素(E)〕、炎性指标〔C反应蛋白(CRP)、白细胞介素(IL-6、IL-8)〕、复发率及随访1年复发情况。上述数据的计数资料以n(%)描述,采用χ^(2)检验;计量资料以x±s描述,采用t检验。结果2组总有效率比较,差异无统计学意义,P>0.05;单鼻孔组手术时间为(157.36±19.54)min,长于双鼻孔组(157.36±19.54)min,差异有统计学意义,t=5.279,P<0.001;术中出血量为(61.59±6.44)mL,高于双鼻孔组(48.36±6.53)mL,差异有统计学意义,t=9.009,P<0.001;住院时间为(10.62±2.14)d,短于双鼻孔组(14.59±2.31)d,差异有统计学意义,t=7.873,P<0.001;治疗费用为(4.12±0.25)万元,低于双鼻孔组(4.25±0.31)万元,差异有统计学意义,t=2.039,P=0.045。术后1和3d单鼻孔组AngⅡ分别为(31.77±5.38)pg/mL、(25.73±4.13)pg/mL,均低于双鼻孔组(43.86±5.44)pg/mL、(30.76±4.75)pg/mL,差异有统计学意义,F组间=16.395,P<0.001;NE分别为(108.53±14.37)ng/mL、(77.82±9.55)ng/mL,均低于双鼻孔组(136.74±13.28)ng/mL、(92.86±10.58)ng/mL,差异有统计学意义,F组间=15.083,P<0.001;E分别为(97.53±15.82)ng/mL、(64.77±10.83)ng/mL,均低于双鼻孔组(129.65±17.44)ng/mL、(78.71±11.54)ng/mL,差异有统计学意义,F组间=13.592,P<0.001;CRP分别为(20.82±2.97)mg/L、(15.37±2.16)mg/L,均低于双鼻孔组(23.76±3.15)mg/L、(17.39±2.11)mg/L,差异有统计学意义,F组间=10.331,P<0.001;IL-6分别为(14.52±2.27)pg/mL、(10.15±1.84)pg/mL,均低于双鼻孔组(16.81±2.13)pg/mL、(12.08±1.92)pg/mL,差异有统计学意义,F组间=8.562,P<0.001;IL-8分别为(16.54±2.18)pg/mL、(12.55±1.98)pg/mL,均低于双鼻孔组(19.22±2.07)pg/mL、(14.73±1.89)pg/mL,差异有统计学意义,F组间=10.625,P<0.001;2组并发症发生率及随访1年复发率比较,差异无统计学意义,均P>0.05。结论神经内镜单鼻孔、双鼻孔入路联合垂体边界辨认技术治疗PA安全性较高,且能获得满意的中短期疗效。单鼻孔入路手术炎性应激反应轻、术后恢复迅速,且能减轻患者经济负担;而双鼻孔入路手术操作难度低,能缩短手术时间。

Objective To explore the application value of different approaches combined with pituitary boundary identification technology under neuroendoscopy in the treatment of pituitary adenoma(PA).Methods Seventy-eight patients with PA who underwent neuroendoscopy combined with pituitary boundary identification in Suixian People's Hospital from September to January,2018to July to January,2021were divided into single nostril group(n=39)and double nostril group(n=39)according to the approach.The therapeutic effect,surgical indicators,stress indicators before and after operation[angiotensinⅡ(AngⅡ),norepinephrine(NE)and epinephrine(E)],inflammatory indicators[C-reactive protein(CRP),interleukin(IL-6,IL-8)],recurrence rate and recurrence after one-year follow-up were compared between the two groups.The counting data of the above data were described by n(%)and tested by χ^(2);The measurement data were described by x±s,and t test was used.Results There was no significant difference between the two groups in total effectiveness(P>0.05).The operation time of single-nostril group was(157.36±19.54)min,which was longer than that of double-nostril group(157.36±19.54)min(t=5.279,P<0.001).The intraoperative blood loss was(61.59±6.44)ml,which was higher than that in the double-nostril group(48.36±6.53)ml(t=9.009,P<0.001).The length of hospital stay was(10.62±2.14)d,which was shorter than that of binnostril group(14.59±2.31)d(t=7.873,P<0.001).The treatment cost was(41200±2500)yuan,which was lower than that of double nostril group(42500±3100)yuan(t=2.039,P=0.045).AngⅡin single-nostril group was(31.77±5.38)pg/ml and(25.73±4.13)pg/ml on day 1and day 3after operation,respectively,which were lower than those in double-nostril group(43.86±5.44)pg/ml and(30.76±4.75)pg/ml,with a statistically significant difference(FIntergroup=16.395,P<0.001);The NE values were(108.53±14.37)ng/ml and(77.82±9.55)ng/ml,respectively,lower than those in binnostril group(136.74±13.28)ng/ml and(92.86±10.58)ng/ml(FIntergroup=15.083,P<0.001).E were(97.53±15.82)ng/ml and(64.77±10.83)ng/ml,respectively,which were lower than those in double-nostril group(129.65±17.44)ng/ml and(78.71±11.54)ng/ml(FIntergroup=13.592,P<0.001).The CRP levels were(20.82±2.97)mg/L and(15.37±2.16)mg/L,respectively,lower than those in binnostril group(23.76±3.15)mg/L and(17.39±2.11)mg/L(FIntergroup=10.331,P<0.001).IL-6values were(14.52±2.27)pg/ml and(10.15±1.84)pg/ml,respectively,lower than those in binnostril group(16.81±2.13)pg/ml and(12.08±1.92)pg/ml(FIntergroup=8.562,P<0.001).IL-8values were(16.54±2.18)pg/ml and(12.55±1.98)pg/ml,respectively,lower than those in binnostril group(19.22±2.07)pg/ml and(14.73±1.89)pg/ml(FIntergroup=10.625,P<0.001).There was no significant difference between the two groups in the incidence of complications and the recurrence rate after one-year follow-up(P>0.05).Conclusions Single nostril approach and double nostril approach combined with pituitary boundary identification technique in the treatment of PA is safe and can achieve satisfactory short and medium term efficacy.The single nostril approach has light inflammatory stress response,rapid postoperative recovery,and can reduce the economic burden of patients.However,the operation difficulty is low through the doublenostril approach,which can shorten the operation time.