鼻内镜下单鼻孔经鼻蝶垂体瘤切除术的治疗效果  

Research on the effect of endoscopic single nostril transsphenoidal pituitary tumor resection

作　　者：周凯[1] 范雁东[1] 吴鹏飞[1] 吉文玉[1] 冯兆海[1] 张庭荣[1] 

机构地区：[1]新疆医科大学第一附属医院神经外科,新疆乌鲁木齐830054

出　　处：《局解手术学杂志》2016年第8期562-566,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：国家自然科学基金(81160150);新疆维吾尔自治区自然科学基金(2012YFY20)

摘　　要：目的探讨鼻内镜下单鼻孔经鼻蝶垂体瘤切除术对患者临床症状改善及患者相关生存质量的影响。方法选取我院2013年8月至2015年8月收治的114例垂体瘤患者,按照随机数字表法分为鼻内镜组与显微镜组,各57例,进行前瞻性对照分析。2组患者分别接受鼻内镜下、显微镜下单鼻孔经鼻蝶入路垂体瘤切除术治疗,比较2组患者手术情况、激素回落情况、并发症发生率及手术前后鼻腔鼻窦结局测量20条(SNOT-20)及疼痛视觉模拟量表(VAS)评分变化。结果鼻内镜组手术时间显著多于显微镜组,其术中出血量、住院时间显著低于后者,差异有统计学意义(P<0.05),2组患者垂体瘤全切率比较,差异无统计学意义(P>0.05)。鼻内镜组术后1周脑脊液细胞数、脑脊液蛋白、促肾上腺皮质激素、血氯、血钠、生长激素、泌乳素水平均低于显微镜组,差异有统计学意义(P<0.05)。鼻内镜组并发症发生率为14.9%,低于显微镜组的59.6%,差异有统计学意义(P<0.05)。2组患者术后1周SNOT-20评分、VAS评分均显著升高,显微镜组升高更为明显,差异有统计学意义(P<0.05)。结论鼻内镜下单鼻孔经鼻蝶垂体瘤切除术手术时间较长,但对患者造成的创伤显著低于显微镜下手术,且术后并发症发生率更低,有助于延缓术后患者生存质量的下降,促进患者预后的改善。Objective To discussion the effect of endoscopic single nostril transsphenoidal pituitary tumor resection on improving clinical symptoms and related quality of life of patients. Methods Selected 114 cases of patients with pituitary tumors in our hospital from August 2013 to August 2015, and randomly divided them into the nasal endoscopic group and the microscopic group according to the random number table, with 57 patients in each group. Patients of the 2 groups were treated with nasal endoscopic and microscopic single nostril transsphenoidal pituitary tumor resection respectively. The operation situation, hormone decline ,incidence of complications after surgery and SNOT-20 and VAS score of the two groups were compared. Results Operative time of nasal endoscopic group was significantly higher than that in the mi- croscopic group, whlie the blood loss,length of hospital stay in endoscopic group was significantly lower than the microscopic group, and the difference was statistically significant （ P 〈 0.05 ）. The total resection rate of pituitary tumor of the two groups were of no statistically significance （ P 〉 0.05 ）. One week after operation, cerebrospinal fluid cell count, eerebrospinal fluid protein, adrenoeorticotropic hormone, serum chloride, sodium, growth hormone, and prolactin levels of the nasal endoscopic group were lower than the microscopic group （ P 〈 0.05 ）. The complication rate was 14.9% in the nasal endoscopic group,which was obviously lower than 59.6% in the microscopic group （P 〈0.05 ）. One week after operation,the SNOT-20 scores and VAS scores were increased in both of the two groups,but the microscopic group increased more significantly （ P 〈 0.05）. Conclusion Endoscopic single nostril transsphenoidal pituitary tumor resection surgery cost longer operation time, but it lead to less trauma and less postoperative complications, which may delay the decline of patients＇ quality of life and promote the improvement of prognosis.

关 键 词：鼻内镜 经鼻中隔-蝶窦入路 垂体瘤切除术 鼻部相关生存质量 

分 类 号：R739.41[医药卫生—肿瘤]