神经内镜经鼻手术治疗垂体腺瘤快速康复技术的探讨  

Rapid rehabilitation technology of neuroendoscopic transnasal surgery for pituitary adenomas

作　　者：白吉伟[1,2,3] 李储忠 曹磊 赵澎[1,3] 刘春晖 耿素民[1,3] 桂松柏 张亚卓[1,2,3] Bai Jiwei;Li Chuzhong;Cao Lei;Zhao Peng;Liu Chunhui;Geng Sumin;Gui Songbai;Zhang Yazhuo(Department of Neurosurgery,Beijing Tiantan Hospital;Beijing Neurosurgical Institute;China National Clinical Research Center for Neurological Diseases,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100070 [2]北京市神经外科研究所 [3]国家神经系统疾病临床医学研究中心

出　　处：《中国微侵袭神经外科杂志》2021年第9期421-425,共5页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：国家自然科学基金资助项目(编号:81771489);北京市科学技术委员会资助(编号:Z171100000117002)。

摘　　要：目的为改善病人生活质量、促进快速康复,探讨常规垂体腺瘤手术治疗策略。方法回顾性分析417例神经内镜经鼻手术治疗垂体腺瘤病人的临床资料,依据术前MRI表现分为常规垂体腺瘤组120例和对照组297例。常规垂体腺瘤组采用经典的经鼻腔蝶窦入路,对照组采用扩大经鼻入路,分析两组治疗效果。结果常规垂体腺瘤组全切除112例(93.3%),近全切除7例,部分切除1例;对照组全切除232例(78.1%),近全切除59例,部分切除6例。常规垂体腺瘤组符合快速康复标准103例(85.8%),住院费用中位数3.4万元;对照组符合快速康复标准18例(6.1%),住院费用中位数4.5万元,两组差异均具有统计学意义(P<0.01)。结论通过术前精准评估,识别常规垂体腺瘤,术中注意保护正常结构,避免医源性损伤,有助于减轻病人术后不适,促进病人快速康复。Objective To explore the surgical treatment strategies for improving the life quality and promoting rapid recovery of patients with pituitary adenomas.Method Clinical data of 417 patients with pituitary adenomas treated with neuroendoscopic transnasal surgery were analyzed retrospectively,and the patients were divided into the routine pituitary adenoma group(n=120)and the control group(n=297)based on preoperative MRI findings.The classic endoscopic endonasal approaches were applied in the routine pituitary adenoma group and expended endoscopic endonasal approaches were used in the control group.Then,the treatment effects were analyzed.Results Total tumor resection was achieved in 112 patients(93.3%),subtotal resection in 7 and partial resection in 1 in the routine pituitary adenoma group,and total tumor resection was achieved in 232 patients(78.1%),subtotal resection in 59 and partial resection in 6 in the control group.133 patients(85.8%)reached the criteria of rapid rehabilitation and the median hospitalization cost was 34000 yuan in the routine pituitary adenoma group,while 18 patients(6.1%)reached the criteria of rapid rehabilitation and the median hospitalization cost was 45000 yuan in the control group.And there were significant differences in rapid rehabilitation and hospital cost between the two groups(P<0.01).Conclusions Routine pituitary adenomas can be identified by accurate preoperative assessment,protection of normal structures during the operation and avoidance of iatrogenic injuries is helpful to relieve postoperative discomfort and promote rapid rehabilitation of the patients.

关 键 词：垂体腺瘤 神经内镜 经鼻入路 快速康复技术 

分 类 号：R651.11[医药卫生—外科学]