经不同鼻-蝶窦入路神经内镜切除术治疗垂体瘤的疗效及对嗅觉功能的影响

Efficacy of neuroendoscopic resection via different transnasal-pterygoid sinus approaches for pituitary tumors and their effects on olfactory function

目的分析经不同鼻-蝶窦入路神经内镜切除术治疗垂体瘤的疗效及对嗅觉功能的影响。方法回顾性抽取2021年10月至2023年11月于郑州大学第一附属医院接受经鼻-蝶窦入路神经内镜切除术治疗的垂体瘤患者60例, 按照基线资料可比性原则分为单侧组、单侧半鼻孔组和双侧组, 每组20例。单侧组选择经典单侧鼻孔入路;单侧半鼻孔组选择单侧半鼻孔入路;双侧组选择双侧鼻孔入路。比较三组手术相关指标、肿瘤切除情况、临床疗效、手术前后嗅觉功能。结果三组手术时间、术中出血量、肿瘤切除率比较, 差异有统计学意义(P<0.05);双侧组手术时间短于单侧组、单侧半鼻孔组, 双侧组术中出血量少于单侧组、单侧半鼻孔组, 双侧组肿瘤切除率高于单侧组、单侧半鼻孔组, 差异有统计学意义(P<0.05)。双侧组总有效率(95.00%, 19/20)高于单侧组、单侧半鼻孔组(85.00%, 17/20;80.00%, 16/20), 但差异未见统计学意义(P>0.05)。术前、术后1周, 三组嗅觉功能评分比较差异未见统计学意义(P>0.05);术后1、3个月, 单侧组嗅觉功能评分与单侧半鼻孔组比较差异未见统计学意义(P>0.05), 单侧组、单侧半鼻孔组嗅觉功能评分高于双侧组(P<0.05)。结论经不同鼻-蝶窦入路神经内镜切除术治疗垂体瘤的疗效相似, 双侧鼻孔入路手术时间、术中出血控制、肿瘤切除范围优于单侧鼻孔入路和单侧半鼻孔入路, 而单侧鼻孔入路、单侧半鼻孔入路对术后嗅觉功能的影响小于双侧鼻孔入路。

Objective To analyze the efficacy of neuroendoscopic resection via different transnasal-pterygoid sinus approaches for pituitary tumors and their effects on olfactory function.Methods Sixty patients with pituitary tumors who underwent neuroendoscopic resection via transnasal-pterygoid sinus approach in the First Affiliated Hospital of Zhengzhou University from October 2021 to November 2023 were retrospectively selected as study subjects,and they were divided into unilateral group,unilateral heminasal group,and bilateral group according to the principle of comparability of baseline data,with 20 cases in each group.The unilateral group was treated by resection via unilateral nostril approach,the unilateral heminasal group was treated by surgery via unilateral heminasal approach,and the bilateral group was treated by surgery via bilateral nostril approach.The operation-related indexes,tumor resection,clinical efficacy,and olfactory function before and after surgery were compared among the three groups.Results There were statistically significant differences in operation time,intraoperative blood loss and tumor resection rate among the three groups(P<0.05).The bilateral group had shorter operation time,less intraoperative blood loss and higher tumor resection rate compared with the unilateral group and the unilateral heminasal group(P<0.05).The total effective rate of the bilateral group(95.00%,19/20)was higher than that of the unilateral group(85.00%,17/20)and the unilateral heminasal group(80.00%,16/20),but the difference was not statistically significant(P>0.05).There was no significant difference in olfactory function scores among the three groups before and 1 week after surgery(P>0.05).One and 3 months after surgery,there was no significant difference in the olfactory function score between the unilateral group and the unilateral heminasal group(P>0.05);however,the olfactoty function scores of the unilateral group and unilateral heminasal group were higher than that of the bilateral group 1 and 3 months after surgery(P<0.05).Conclusions Neuroendoscopic resections via different transnasal-pterygoid sinus approaches have similar efficacy in the treatment of pituitary tumors.In addition,the neuroendoscopic resections via bilateral nostril approach is more effective in terms of operation time,intraoperative hemorrhage control,and extent of tumor resection compared with the resections via unilateral nostril approach and unilateral heminasal approach;whereas unilateral nostril approach and the unilateral heminasal approach have less impact on postoperative olfactory function compared with the bilateral nostril approach.