不同经鼻-蝶窦入路神经内镜切除术治疗垂体瘤的安全性及有效性研究  

Safety and effectiveness of different approach neuroendoscopic transnasal-sphenoidal resection for pituitary adenoma

作　　者：郭卉[1] 黄萍[2] 熊莉娜 Guo Hui;Huang Ping;Xiong Lina(Department of Otolaryngology,Liyuan Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan 430077,China;Department of Ophthalmology,Liyuan Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan 430077,China;Department of Gastroenterology,Liyuan Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan 430077,China)

机构地区：[1]华中科技大学同济医学院附属梨园医院耳鼻喉科,湖北武汉430077 [2]华中科技大学同济医学院附属梨园医院眼科,湖北武汉430077 [3]华中科技大学同济医学院附属梨园医院消化内科,湖北武汉430077

出　　处：《中国医刊》2021年第1期56-60,共5页Chinese Journal of Medicine

基　　金：湖北省自然科学基金面上项目(2013CFB117)。

摘　　要：目的比较不同经鼻-蝶窦入路神经内镜切除术治疗垂体瘤的安全性及有效性。方法回顾分析2016年1月至2019年3月在华中科技大学同济医学院附属梨园医院接受神经内镜下经鼻-蝶窦入路垂体瘤切除术治疗的患者102例,根据入路方式的不同分为经典单侧鼻孔入路组(A组,52例)、一侧半鼻孔入路组(B组,19例)和双侧鼻孔入路组(C组,31例)。比较三组患者的肿瘤切除情况、围术期指标、术后症状改善、嗅觉改变及并发症发生情况等。结果三组整体肿瘤切除情况比较差异无显著性(P>0.05),但B、C组巨腺瘤全/次全切除率显著高于A组(P<0.05)。A、B组的手术时间、术中出血量、住院时间均明显低于C组(P<0.05),但A、B组间比较差异无显著性(P>0.05)。三组症状改善情况比较差异无显著性(P>0.05)。术后1周及3个月时,A、B组的T&T标准嗅觉测试评分明显低于C组(P<0.05),但A、B组间比较差异无显著性(P>0.05)。A、B组术后并发症发生率分别为15.38%、21.05%,均低于C组(45.16%),差异有显著性(P<0.05)。结论单侧鼻孔、一侧半鼻孔与双侧鼻孔经鼻-蝶窦入路神经内镜切除术治疗垂体瘤均有良好疗效,但后两种入路对巨大肿瘤的切除效果更好,前两种入路的创伤更小,一侧半鼻孔入路可能是对单、双侧入路的改进与补充。Objective To compare the safety and effectiveness of different approach neuroendoscopic transnasal-sphenoidal resection for pituitary adenoma(PA).Method The clinical data of 102 patients with PA who underwent neuroendoscopic transnasal-sphenoidal resection in our hospital from January 2016 to March 2019 were retrospectively analyzed.The patients were divided into classical unilateral nostril approach group(group A,n=52),one-and-a-half approach group(group B,n=19)and bilateral approach group(group C,n=31)according to the different kinds of transsphenoidal approaches.The perioperative conditions,postoperative symptom improvement,complications and olfactory function of the three groups were compared.Result There was no statistically significant difference in the overall tumor resection effect among the three groups,but the total/subtotal total resection rate of giant adenoma in groups B and C was significantly higher than that in group A(P<0.05).The operation time,intraoperative blood loss,and hospital stay in group A and group B were lower than those in group C(P<0.05),but there was no statistically significant difference between groups A and B(P>0.05).The symptom improvement among the three groups was not statistically significant(P>0.05).At 1 week and 3 months after operation,the T&T standard olfactory test scores of groups A and B were significantly lower than those of group C(P<0.05),but there was no statistically significant difference between group A and group B(P>0.05).The complication rates in groups A and B were 15.38%and 21.05%,which were lower than 45.16%in group C(P<0.05).Conclusion Unilateral nostril,one-and-a-half of the nostril and bilateral nostril approach of neuroendoscopic transnasal-sphenoidal resection have good effect for PA,the latter two are better for the removal of huge tumors,the former two with lighter trauma.It may be a good supplement and improvement to unilateral nostril and bilateral nostril approach.

关 键 词：垂体瘤 神经内镜 单侧鼻孔入路 双侧鼻孔入路 一侧半鼻孔入路 

分 类 号：R736.4[医药卫生—肿瘤] R651.13[医药卫生—临床医学]