神经内镜辅助下经鼻蝶窦手术治疗垂体瘤的效果及对嗅觉功能、神经内分泌激素水平的影响

Effect of endoscopic sinus surgery on pituitary adenoma and its influence on olfactory function and level of neuroendocrine hormone

目的:探讨神经内镜辅助下经鼻蝶窦手术治疗垂体瘤的效果及对嗅觉功能、神经内分泌激素水平的影响。方法:回顾性将我院2018年03月至2022年02月收治的垂体瘤患者58例作为此次的研究对象,其中采用显微镜辅助下进行经鼻蝶窦手术的28例作为对照组,神经内镜辅助下进行经鼻蝶窦手术的30例作为观察组,均观察至患者出院,并进行随访1年。比较两组围术期指标,术后1个月视力下降、头痛及性功能障碍缓解率,术前、术后1个月激素水平、T细胞亚群、生活质量评分、嗅觉功能,研究期间并发症发生情况,随访1年后复发情况。结果:与对照组比较,观察组的出血量相对更少,术后住院时间较短,肿瘤全切率相对更高;术后1个月,与对照组进行比较,观察组视力下降、头痛及性功能障碍缓解率均相对更高;相比术前,两组术后1个月血清泌乳素(PRL)、促甲状腺素(TSH)、生长激素(HGH)、促肾上腺皮质激素(ACTh)水平均降低,观察组低于对照组,外周血CD3^(+)、CD4^(+)水平、CD4^(+)/CD8^(+)值、社会功能、躯体功能、心理功能、物质生活状态各项生活质量评分术后1个月则均升高,观察组高于对照组;与术前比较,两组术后1个月嗅觉功能均升高,但观察组低于对照组;研究期间,观察组并发症总发生率3.33%低于对照组的25.00%;随访1年后,观察组的复发率0.00%同样低于对照组的14.29%(P<0.05)。结论:神经内镜辅助下经鼻蝶窦手术可有效提高垂体瘤患者的生活质量以及视力下降、头痛等临床症状缓解率,缩短住院时间,同时还能够改善患者的免疫功能以及嗅觉功能,稳定患者神经内分泌激素水平,降低并发症发生以及复发率。

Objective:To explore the effect of endoscopic sinus surgery on pituitary adenoma and its influence on olfactory function and level of neuroendocrine hormone.Methods:58 patients with pituitary adenoma treated in our hospital from March,2018 to February,2022 were studied retrospectively.Among them,28 patients underwent transsphenoidal surgery with microscope as the control group,and 30 patients underwent transsphenoidal surgery with neuroendoscope as the observation group.All patients were observed to be discharged from hospital and followed up for one year.The perioperative indicators,the remission rate of vision loss,headache and sexual dysfunction one month after operation,levels of hormone,T cell subsets,score of quality of life and olfactory function before and one month after operation,the occurrence of complications during the study period and the recurrence after one year of follow-up were compared between the two groups.Results:Compared with the control group,the amount of bleeding in the observation group relatively less,the postoperative hospitalization time was shorter,and the total tumor resection rate was relatively higher.One month after operation,compared with the control group,the remission rate of vision loss,headache and sexual dysfunction in the observation group was relatively higher.Compared with before operation,the levels of serum prolactin(PRL),thyrotropin(TSH),growth hormone(HGH)and adrenocorticotropic hormone(ACTh)in the two groups decreased one month after operation,the observation group was lower than the control group,and the levels of peripheral CD3^(+),CD4^(+),CD4^(+)/CD8^(+),social function,physical function,psychological function and material life status were increased one month after operation,the observation group was higher than the control group.Compared with before operation,the olfactory function of both groups increased one month after operation,but the observation group was lower than the control group.During the study,the total incidence of complications in the observation group was 3.33%,lower than that in the control group(25.00%).After one year's follow-up,the recurrence rate of 0.00% in the observation group was also lower than that of the control group(14.29%)(P<0.05).Conclusion:Endoscopic transsphenoidal surgery could effectively improve the quality of life of patients with pituitary adenoma,the remission rate of clinical symptoms such as decreased vision and headache,shorten the hospitalization time,improve the immune function and olfactory function of patients,stabilize the level of neuroendocrine hormones,and reduce the occurrence and recurrence rate of complications.