经鼻蝶入路切除垂体病变后的鼻部症状研究  

Nasal symptoms after transsphenoidal surgery for pituitary lesions

作　　者：陈业煌 赵琳 李建忠 魏梁锋 洪景芳 王守森 Chen Yehuang;Zhao Lin;Li Jianzhong;Wei Liangfeng;Hong Jingfang;Wang Shousen(Hospital of Joint Logistics Team,Fuzhou 350025,China)

机构地区：[1]联勤保障部队第九OO医院神经外科,福州350025

出　　处：《中华神经医学杂志》2022年第3期278-283,共6页Chinese Journal of Neuromedicine

基　　金：福建省科技计划引导性项目(2018Y0067)。

摘　　要：目的评估显微镜下经鼻蝶入路垂体病变切除术后患者鼻部症状的临床转归。方法前瞻性选择联勤保障部队第九OO医院神经外科自2012年3月至2013年1月采用显微镜下经鼻蝶入路切除术治疗的53例垂体病变患者进入研究。术前、术后1周、术后1个月、术后4个月时采用中文版鼻腔鼻窦结局测试22条(SNOT-22)量表评估患者的鼻部症状,术前、术后1周、术后4个月时采用五味试嗅液法评估患者的嗅觉。结果53例垂体病变中垂体腺瘤47例,Rathke囊肿6例;术后常见鼻部症状有鼻腔疼痛、鼻塞、流涕、头昏、嗅觉障碍。术后1周、术后1个月时患者SNOT-22量表22个条目总评分、5大条目评分均高于术前,差异均有统计学意义(P<0.05);与术后1周比较,术后1个月时患者SNOT-22量表22个条目总评分、5大条目评分均下降,差异均有统计学意义(P<0.05);术前与术后4个月间患者SNOT-22量表22个条目总评分、5大条目评分的差异均无统计学意义(P>0.05)。术后1周、术后4个月时患者嗅觉障碍发生率均高于术前,差异均有统计学意义(P<0.05);与术后1周相比,术后4个月时患者嗅觉障碍发生率降低,但差异无统计学意义(P>0.05)。结论显微镜下经鼻蝶入路垂体病变切除术后可发生一定程度的嗅觉障碍,恢复较慢,值得重视。Objective To analyze the clinical outcome of nasal symptoms in patients with pituitary lesions after transsphenoidal surgery by microscope.Methods A perspective study was performed;53 patients with pituitary lesions treated by transsphenoidal microsurgery in our hospital from March 2012 to January 2013 were enrolled.Sinonasal outcome test(SNOT)-22 was used to evaluate the nasal symptoms in these patients before surgery,and 1 week,1 month and 4 months after surgery;Toyota and Takagi(T&T)olfactometer was used to evaluate the olfaction before surgery,and 1 week and 4 months after surgery.Results Among the 53 patients,47 were with pituitary adenoma and 6 were with Rathke cysts.The common postoperative nasal symptoms included olfactory disorder,nasal obstruction,runny nose,pain in the nasal cavity and dizziness.The total scores and 5-items scores of SNOT-22 in patients 1 week and 1 month after surgery were significantly higher as compared with those before surgery(P<0.05);there were no significant differences in these scores between before surgery and 4 months after surgery(P>0.05).The incidence of olfactory disorder in patients 1 week and 4 months after surgery was significantly higher than that before surgery(P<0.05);the incidence of olfactory disorder in patients 4 months after surgery was decreased as compared with that 1 week after surgery,without significant difference(P>0.05).Conclusion Olfactory disorder can occur to some extent after transsphenoidal approach with slow recovery,which deserves the attentions.

关 键 词：经鼻蝶入路 显微外科手术 嗅觉障碍 鼻部症状 

分 类 号：R736.4[医药卫生—肿瘤]