内镜下两种入路232例垂体瘤切除术对嗅觉功能影响的临床观察  

Clinical observation of the effects of two endoscopic approaches on olfactory function in 232 patients undergoing pituitary tumor resection

作　　者：王会[1] 程莲[1] 徐淑军[1] WANG Hui;CHENG Lian;XU Shujun(Department of Neurosurgery,Qilu Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250012,Shandong,China)

机构地区：[1]山东大学齐鲁医院神经外科,山东济南250012

出　　处：《山东大学学报（医学版）》2020年第8期95-100,共6页Journal of Shandong University:Health Sciences

基　　金：山东大学齐鲁医院科研基金护理项目(2017QLHL05)。

摘　　要：目的通过对接受经鼻直接蝶窦入路和经鼻中隔黏膜下入路垂体腺瘤切除术的两组患者进行嗅觉测试,结合临床数据资料,分析比较两组患者嗅觉功能的变化,探讨其对临床的指导意义。方法收集2017年1月至2018年4月在我院神经外科收治的232例垂体瘤患者,根据不同手术入路方式分为观察组和对照组;研究期间将经鼻中隔黏膜下入路手术的患者149例纳入观察组,将直接蝶窦入路手术的患者83例纳入对照组,采用五味试嗅法测试两组患者手术前后不同时间点嗅觉察觉阈值和识别阈值。结果术前观察组和对照组察觉阈值分别是1.70±0.30、1.67±0.36,识别阈值分别是2.22±0.52、2.26±0.50,两组患者嗅觉阈值差异无统计学意义(P>0.05);术后1个月观察组和对照组察觉阈值分别是3.22±0.99、3.56±0.91(P=0.011),识别阈值分别是3.79±0.84、4.34±0.82(P<0.001),两组患者的嗅觉阈值差异有统计学意义(P<0.05),且对照组较观察组患者的嗅觉察觉阈值和识别阈值高;术后3个月观察组和对照组察觉阈值分别是2.69±0.70、3.05±0.97(P=0.003),识别阈值分别是3.31±0.74、3.84±0.76(P<0.001),两组患者的嗅觉阈值差异有统计学意义(P<0.05);术后6个月时观察组和对照组察觉阈值分别是2.21±0.64、2.66±0.79(P<0.001),识别阈值分别是2.98±0.64、3.44±0.55(P<0.001),两组患者之间的嗅觉阈值差异有统计学意义(P<0.01),且对照组较观察组患者的察觉阈值和识别阈值高。结论两种术式均可导致患者的嗅觉功能降低,术后6个月随访时嗅觉功能仍不能恢复到术前水平。相比之下,经鼻中隔黏膜下入路垂体腺瘤切除术对患者的嗅觉功能影响较小。Objective To compare the changes of olfactory function in two groups of patients who underwent endoscopic transsphenoidal approach(ETSA)and endoscopic nasal septum submucosal approach for pituitary adenoma resection.Methods A total of 232 patients with pituitary adenoma treated in our hospital during Jan.2017 and Apr.2018 were prospectively divided into the observation group(nasal septum submucosal approach,n=149)and control group(ETSA,n=83).Olfactory detection threshold(DT)and recognition threshold(RT)were measured at different time points before and after operation by five-taste method.Results Before operation,DT was 1.70±0.30 in the observation group and 1.67±0.36 in the control group,and RT was 2.22±0.52 and 2.26±0.50,respectively(P>0.05).One month after operation,DT rose to 3.22±0.99 and 3.56±0.91,respectively(P=0.011),and RT rose to 3.79±0.84 and 4.34±0.82(P<0.001).There were significant differences between the two groups(P<0.05),and the control group had higher DT and RT than the observation group.Three months after operation,DT was 2.69±0.70 in the observation group and 3.05±0.97 in the control group(P=0.003),and RT was 3.31±0.74 and 3.84±0.76,respectively(P<0.001).There were significant differences between the two groups(P<0.05).Six months after operation,DT was 2.21±0.64 in the observation group and 2.66±0.79 in the control group(P<0.001),and RT was 2.98±0.64 and 3.44±0.55,respectively(P<0.001).There were significant differences between the two groups(P<0.01),and the control group had higher DT and RT than the observation group.Conclusion Both approaches could affect the olfactory function,which could not return to the pre-operative level 6 months after operation.Compared with ETSA,the endoscopic nasal septum submucosal approach caused less damage to olfactory function.

关 键 词：鼻中隔黏膜下入路 直接蝶窦入路 垂体腺瘤 嗅觉障碍 

分 类 号：R619[医药卫生—外科学]