神经内镜与显微镜经鼻蝶垂体腺瘤切除术疗效对比

Comparative Analysis of the Efficacy of Neuroendoscopic and Microscopic Transnasal Resection of Pituitary Tumours in the Pterygoid Region

目的探讨神经内镜和显微镜下经鼻蝶垂体腺瘤切除术治疗垂体腺瘤的临床疗效。方法回顾性分析2019年1月至2023年12月昆明医科大学第一附属医院神经外科治疗的150例垂体腺瘤患者的临床资料,按手术方式分为显微镜组(n=100)和神经内镜组(n=50),比较2种手术方式对垂体腺瘤的临床疗效。结果2组手术患者中,Knosp分级0~Ⅱ级的全切率神经内镜组(97.6%)和显微镜组(95.1%)差异无统计学意义(P>0.05),Knosp分级Ⅲ~Ⅳ级的全切率神经内镜组(66.7%)明显高于显微镜组(10.5%),术后住院时间、原发症状改善率神经内镜组优于显微镜组,差异有统计学意义(P<0.05)。手术时间显微镜组略短于神经内镜组,术中大流量脑脊液漏发生率、术中出血量、术后激素水平变化、术后并发症发生率2组均差异无统计学意义(P>0.05)。结论2种手术方式对于垂体腺瘤患者均有较好的治疗效果,对于KnospⅢ~Ⅳ级的垂体腺瘤全切率,神经内镜高于显微镜,临床上还需根据肿瘤的分型及患者的一般情况等来选择最适合患者的手术方式。

Objective To analyze the clinical effectiveness of neuroendoscopy and microscopy in the treatment of hypophysectomy.Methods The clinical data of 150 patients with pituitary adenoma treated in the Department of Neurosurgery,the First Affiliated Hospital of Kunming Medical University from January 2019 to December 2023 were retrospectively analyzed.According to the surgical methods,they were divided into the microscope group(n=100)and the neuroendoscopy group(n=50).The clinical efficacy of the two surgical methods on pituitary adenoma was compared.Results In the two groups of surgical patients,there was no significant difference between the total incision rate of Knosp grade 0-Ⅱ in the neuroendoscopy group(97.6%)and the microscopy group(95.1%),the total incision rate of Knosp grade Ⅲ-Ⅳ in the neuroendoscopy group(66.7%)was significantly higher than that of the microscopy group(10.5%),The postoperative hospital stay and the rate of improvement of primary symptoms were better in the neuroendoscopic group than in the microscopic group,and the difference was highly significant(P<0.05).There was no significant difference in rates of CSF leak,hemorrhage,hormonal changes,or complications between these two groups(P>0.05).Conclusion Both surgical methods have good therapeutic effects on patients with pituitary adenomas.For Knosp grade Ⅲ to Ⅳ pituitary adenomas,the total resection rate is higher with neuroendoscopy than with microscopy.The clinical decision to use either technique depends on the type of tumor and the patient's general condition.