神经内镜下经鼻蝶窦扩大鞍底入路颅咽管瘤切除术在复杂性颅咽管瘤患者中的应用

Application effect analysis of craniopharyngioma resection through nasal sphenoid sinus enlargement sellar floor approach under neuroendoscope in patients with complex craniopharyngioma

目的分析神经内镜下经鼻蝶窦扩大鞍底入路颅咽管瘤切除术在复杂性颅咽管瘤患者中的应用效果。方法选择行神经内镜下经鼻蝶窦扩大鞍底入路颅咽管瘤切除术治疗的复杂性颅咽管瘤患者48例作为研究组,另择同期接受开颅入路颅咽管瘤切除术治疗的复杂性颅咽管瘤患者48例作为对照组。比较两组手术情况、临床缓解率与肿瘤全切率,垂体功能、炎症反应、应激指标,并发症等情况。结果研究组手术时间、肿瘤切除时间、住院时间更短(P<0.05);研究组全切除率、临床缓解率更高(P<0.05)。术后1个月两组血清促甲状腺激素(TSH)、生长激素(GH)、促肾上腺皮质激素(ACTH)、总甲状腺素(TT4)水平降低,但研究组高于对照组(均P<0.05)。术后1 d,两组全血中性粒细胞计数与淋巴细胞比值(NLR)、血清降钙素原(PCT)、C反应蛋白(CRP)、白介素-6(IL-6)、血管紧张素Ⅱ(AngⅡ)、肾上腺素(E)、去甲肾上腺素(NE)水平提高,但研究组低于对照组(均P<0.05)。至术后1个月,研究组并发症发生率更低(16.67%vs 45.83%,P<0.05)。对照组复发7例,经手术治疗后,全切4例,次全切2例,部分切除1例;术后并发症发生情况,3例发生尿崩症,1例发生颅内感染。研究组复发8例,经手术治疗后,全切6例,次全切2例;术后并发症发生情况,2例发生尿崩症。结论神经内镜下经鼻蝶窦扩大鞍底入路颅咽管瘤切除术可提高复杂性颅咽管瘤患者临床缓解率与肿瘤全切率,降低炎症反应、应激指标,改善垂体功能,安全性较高,对复发性颅咽管瘤的治疗效果也良好。

Objective To analyze the application effect of craniopharyngioma resection through nasal sphenoid sinus enlargement sellar floor approach under neuroendoscope in patients with complicated craniopharyngioma.Methods From December 2018 to December 2022,48 patients with complex craniopharyngioma who received craniopharyngioma resection through nasal sphenoid sinus enlargement sellar floor approach under neuroendoscope of Baoding Second Central Hospital of neurosurgery were selected as the experimental group,and 48 patients with complex craniopharyngioma who received craniopharyngioma resection via nasal sphenoid sinus during the same period were selected as the control group,postoperative monitoring of the patient's water,electrolyte,central venous pressure and other indicators,timely review of pituitary hormones,according to the review of hormones to supplement the corresponding hormone.,the pituitary hormone should be rechecked in time,and the corresponding hormone should be supplemented according to the rechecked hormone situation.Clinical data of patients were collected retrospectively.The surgical situation,clinical remission rate and total tumor resection rate,pituitary function before and 1 month after surgery,inflammatory reaction and stress index before and 1 d after surgery,and complications 1 month after surgery were compared between the two groups.Results Compared with the control group,the experimental group had shorter operation time,tumor resection time and hospital stay(P<0.05).There was no significant difference in intraoperative blood loss between the two groups(P>0.05).The total resection rate and clinical remission rate of experimental group were 70.83%(34/48)and 85.42%(41/48),which were higher than those of control group 43.75%(21/48)and 60.42%(29/48),the difference was statistically significant(P<0.05).There was no significant difference between the two groups in near-total resection,subtotal resection and majority resection(P>0.05).Compared with before surgery,the serum levels of thyrotropin(TSH),growth hormone(GH),adrenocorticotropic hormone(ACTH)and total thyroxin(TT4)in the two groups decreased 1 month after surgery,and those in the experimental group were higher(P<0.05).Compared with before surgery,whole blood level of neutrophils count to lymphocyte ratio(NLR)1 d after surgery in the two groups increased,but lower in the experimental group(P<0.05).Compared with before surgery,serum levels of procalcitonin(PCT),C-reactive protein(CRP),interleukin-6(IL-6),angiotensinⅡ(AngⅡ),epinephrine(E)and norepinephrine(NE)in the two groups increased 1 d after surgery,but lower in the experimental group(P<0.05).1 month after surgery,the complication(including diabetes insipidus,hypopituitarism,cranial nerve injury,cerebrospinal fluid leakage,intracranial infection,hemiplegia,epilepsy,etc.)rate of the experimental group(16.67%)was lower than that of the control group(45.83%,P<0.05).In the control group,there were 7 cases of recurrence,4 cases of total resection,2 cases of subtotal resection and 1 case of partial resection.The postoperative complications were diabetes insipidus in 3 cases and intracranial infection in 1 case.In the experimental group,there were 8 recurrent cases,6 cases of total resection,2 cases of subtotal resection and 0 cases of partial resection after surgical treatment.The incidence of postoperative complications was diabetes insipidus in 2 cases.Conclusion Craniopharyngioma resection through nasal sphenoid sinus enlargement sellar floor approach under neuroendoscope could improve the clinical remission rate and total tumor resection rate of complex craniopharyngioma patients,reduce inflammatory response and stress indexes,improve pituitary function and safety,the treatment effect of recurrent craniopharyngioma was also good.