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  

Comparison of neuroendoscopic and microscopic endonasal transsphenoidal pituitary adenoma resection and effects on hormone levels

作　　者：毛建辉[1] 郭洪[1] 魏建辉 司娜[1] 郭连峰[1] 邱雷[1] 孙昭胜[1] Jian-hui Mao;Hong Guo;Jian-hui Wei;Na Si;Lian-feng Guo;Lei Qiu;Zhao-sheng Sun(Department of Neurosurgery, Harrison International Peace Hospital, Hengshui, Hebei 053000, China)

机构地区：[1]河北省衡水市哈励逊国际和平医院神经外科,河北衡水053000

出　　处：《中国内镜杂志》2017年第12期25-31,共7页China Journal of Endoscopy

基　　金：衡水科学技术研究与发展计划(No:140003A)

摘　　要：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。Objective To compare the efficacy of neuroendoscopic vs microscopic endonasal transsphenoidal pituitary adenoma resection and effects on hormone levels and clinical symptoms.Methods A retrospective analysis was conducted on211cases with pituitary tumor resection patients from January2012to June2016,of which112cases with endoscopic endonasal transsphenoidal pituitary tumor resection(group A),99cases with microscopic transsphenoidal pituitary tumor resection(group B),and operation related indexes,hormone variations before discharge and symptoms remission24weeks after operation were extracted and compared.Results Two groups of patients with different tumor resection extent(Z=2.14,P=0.032),group A achieved total resection rate was significantly higher than the group B(79.5%vs67.7%)(P=0.037);the operation time of group A was significantly longer than group B[(93.6±26.7)vs(79.8±20.2)min,t=4.26,P=0.000],group A with the mean hospitalization stay was significantly less than group B[(7.9±2.5)vs(10.2±4.3)d,t=4.67,P=0.000],postoperative complications of group A were significantly lower than those of group B(5.4%vs14.1%,χ2=4.73,P=0.030).Two groups of postoperative hormone levels decreased in different degree(Z=2.42,P=0.016),group A with hormone recovery rate before discharge was significantly higher than group B(82.2%vs66.7%,χ2=6.09,P=0.014),and decline on prolactinomas,ACTH adenoma,ghrelin hormone were significantly higher than group B[(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,allP<0.05].There was no significant differences between the two groups in remission of clinical symptoms24weeks after operation(P>0.05).Conclusion Neuroendoscopic endonasal transsphenoidal pituitary adenoma resection is more efficient and less operative complications compared with microscopic surgery,which is more conducive to the recovery of postoperative hormone levels.

关 键 词：垂体瘤 经鼻蝶窦入路垂体瘤切除术 神经内镜 显微镜 并发症 激素 

分 类 号：R736.4[医药卫生—肿瘤]