神经内镜下双侧鼻孔经鼻-蝶窦入路切除术治疗脑垂体瘤的效果

Efficacy of Bilateral Nostril Transnasal-Sphenoidal Approach Resection Under Neuroendoscopy for the Treatment of Pituitary Adenoma

目的分析脑垂体瘤经神经内镜下双侧鼻孔经鼻-蝶窦入路切除术治疗的效果及安全性。方法本研究回顾性分析2019年1月至2023年5月驻马店市中医院收治的89例脑垂体瘤患者临床资料,根据手术入路方式分为对照组(43例,神经内镜下单侧鼻孔经鼻-蝶窦入路)和观察组(46例,神经内镜下双侧鼻孔经鼻-蝶窦入路),分析患者临床资料,比较两组患者围手术期指标、肿瘤切除率、激素水平以及并发症发生情况。结果观察组手术时间、术后住院时间长于对照组,术中出血量多于对照组(P<0.05)。两组微腺瘤/大腺瘤全切率、次切率及部分切除率差异无统计学意义(P>0.05),而观察组巨腺瘤的全切率、次切率高于对照组(P<0.05)。两组术后1周催乳素(PRL)、生长素(GH)、促肾上腺皮质激素(ACTH)水平较术前降低(P<0.05),但两组间术前、术后1周PRL、GH、ACTH水平比较,差异无统计学意义(P>0.05);两组并发症发生率差异无统计学意义(P>0.05)。结论两种入路方式对微腺瘤/大腺瘤均有较好的治疗效果及安全性,虽然神经内镜下双侧鼻孔经鼻-蝶窦入路切除术的手术时间及术后恢复时间长于单侧鼻孔入路,术中出血量多于单侧鼻孔入路,但针对巨腺瘤,双侧鼻孔经鼻-蝶窦入路的切除程度更高。

Objective To analyze the efficacy and safety of neuroendoscopic bilateral nostril transnasal-sphenoidal approach in the treatment of pituitary adenoma.Methods This study retrospectively analyzed the clinical data of 89 patients with pituitary adenoma admitted to Zhumadian TCM Hospital from January 2019 to May 2023.According to different surgical approaches,they were divided into control group(43 cases,unilateral nostril transnasal-sphenoidal approach under neuroendoscope)and observation group(46 cases,bilateral nostril transnasal-sphenoidal approach under neuroendoscope).The clinical data of the patients were analyzed,and the perioperative indexes,tumor resection rate,hormone level and complications were compared between the two groups.Results The operating time and postoperative hospitalization time in the observation group were longer than those in the control group,intraoperative bleeding volume was more than that in the control group(P<0.05).Comparison of total resection rate subtotal resection rate and partial resection rate between two groups of microadenomas/macroadenomas had no statistically difference(P>0.05).The total resection rate and secondary resection rate of giant adenomas in the observation group were higher than those in the control group(P<0.05).The levels of prolactin(PRL),growth hormone(GH),and adrenocorticotropic hormone(ACTH)in the two groups were reduced one week after surgery compared to before surgery(P<0.05),but PRL,GH,and ACTH levels between the two groups before and 1 week after surgery had no statistically difference(P>0.05).The incidence of complications between the two groups had no statistically difference(P>0.05).Conclusion Both approaches have good therapeutic effect and safety for microadenomas/macroadenomas.Although the operation time,intraoperative blood loss and postoperative recovery time of endoscopic bilateral nostril transnasal-sphenoidal approach are slightly higher than those of unilateral nostril approach,for macroadenomas,bilateral nostril transnasal-sphenoidal approach has a higher degree of resection.