神经内镜与显微镜经鼻蝶窦入路切除垂体瘤及对激素水平的影响

目的比较神经内镜下经鼻蝶窦入路垂体瘤切除术与显微镜下垂体瘤切除术的手术效果及对激素水平和临床症状的影响。方法回顾性分析2012年1月-2016年6月在该院经手术切除的211例垂体瘤患者资料。其中,神经内镜下经鼻蝶窦入路垂体瘤切除术112例(A组),显微镜下经鼻蝶窦入路垂体瘤切除术99例(B组),比较两组手术相关指标、出院前激素水平变化及术后24周症状改善情况。结果两组患者肿瘤切除程度不同(Z=2.14,P=0.032),A组达到全切比例明显高于B组(79.5%vs 67.7%,P=0.037);A组手术时间明显长于B组[(93.6±26.7)vs(79.8±20.2)min,t=4.26,P=0.000],A组术后平均住院天数明显少于B组[(7.9±2.5)vs(10.2±4.3)d,t=4.67,P=0.000],A组术后并发症发生率明显低于B组(5.4%vs 14.1%,χ~2=4.73,P=0.030)。两组术后激素水平下降程度不同(Z=2.42,P=0.016),A组出院前激素复常率明显高于B组(82.2%vs 66.7%,χ~2=6.09,P=0.014),出院前A组泌乳素腺瘤、促肾上腺皮质激素腺瘤、生长素腺瘤患者激素下降水平明显高于B组[(43.2±10.5)vs(33.5±9.1)ng/ml、(26.0±8.8)vs(20.2±7.0)pmol/L、(11.0±3.9)vs(8.7±3.2)μg/L,t=3.60、t=2.65、t=2.12,均P<0.05]。两组术后24周临床症状缓解比例差异无统计学意义(P>0.05)。结论神经内镜下经鼻蝶窦入路垂体瘤切除术较显微镜手术垂体瘤切除效率更高,手术并发症更少,更有助于术后激素水平的复常。

不同偏头痛亚型与平衡障碍严重程度的关系

目的探讨先兆性偏头痛、无先兆性偏头痛、慢性偏头痛患者与平衡功能障碍严重程度的关系。方法按照头痛疾患的国际诊断标准,选取偏头痛患者203例。其中,先兆性偏头痛68例,无先兆性偏头痛73例,慢性偏头痛62例。分析3种偏头痛亚型患者的临床资料和平衡障碍严重程度。采用Logistic回归分析平衡严重程度指标与3种偏头痛亚型的关系。结果多因素Logistic回归分析结果显示,移动速度[OR=2.96(95%CI:1.13,9.32)P=0.021]、方向控制[OR=1.47(95%CI:1.03,3.38)P=0.046]是影响先兆性偏头痛患者平衡功能障碍的重要因素;移动速度[OR=3.76(95%CI:1.21,9.28)P=0.042]、步宽[OR=2.45(95%CI:1.73,6.74)P=0.009]是影响无先兆性偏头痛平衡功能障碍的重要因素;移动速度[OR=3.02(95%CI:1.23,8.96),P=0.000],最大位移[OR=1.59(95%CI:1.22,3.67),P=0.043],平均反应时间[OR=1.89(95%CI:1.48,5.35),P=0.041]是影响慢性偏头痛患者平衡功能障碍的重要因素。结论不同偏头痛亚型患者存在轻度或持续加重的平衡功能障碍,其中移动速度是影响先兆性偏头痛、无先兆性偏头痛和慢性偏头痛患者平衡功能障碍的重要因素。

Short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive int-racerebral hemorrhage

BACKGROUND Hypertensive intracerebral hemorrhage is a common critical disease of the nervous system,comprising one fifth of all acute cerebrovascular diseases and has a high disability and mortality rate.It severely affects the patients’quality of life.AIM To analyze the short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage.METHODS From March 2018 to May 2020,118 patients with hypertensive intracerebral hemorrhage were enrolled in our study and divided into a control group and observation group according to the surgical plan.The control group used a hard-channel minimally invasive puncture and drainage procedure.The observation group underwent minimally invasive neuroendoscopic surgery.The changes in the levels of serum P substances(SP),inflammatory factors[tumor necrosis factor-α,interleukin-6(IL-6),IL-10],and the National Hospital Stroke Scale(NIHSS)and Barthel index scores were recorded.Surgery related indicators and prognosis were compared between the two groups.RESULTS The operation time(105.26±28.35)of the observation group was min longer than that of the control group,and the volume of intraoperative bleeding was 45.36±10.17 mL more than that of the control group.The hematoma clearance rates were 88.58%±4.69%and 94.47%±4.02%higher than those of the control group at 48 h and 72 h,respectively.Good prognosis rate(86.44%)was higher in the observation group than in the control group,and complication rate(5.08%)was not significantly different from that of the control group(P>0.05).The SP level and Barthel index score of the two groups increased(P<0.05)and the inflam-matory factors and NIHSS score decreased(P<0.05).The cytokine levels,NIHSS score,and Barthel index score were better in the observation group than in the control group(P<0.05).CONCLUSION Neuroendoscopic minimally invasive surgery is more complicated than hard channel minimally invasive puncture drainage in the treatment of hypertensive intracerebral hemorrhage;however,hematoma clearance is more thorough,and the short-term effect and long-term prognosis are better than hard channel minimally invasive puncture drainage.