经鼻蝶神经内镜垂体瘤切除术治疗垂体瘤的疗效及对患者应激反应、视觉功能的影响  

Clinical efficacy of transsphenoidal neuroendoscopic pituitary tumor resection in the treatment of pituitary tumor and its influence on stress reaction and visual function.

作　　者：郑涛 黄元志 贺世明 ZHENG Tao;HUANG Yuan-zhi;HE Shi-ming(Department of Neurosurgery,Xi'an International Medical Center Hospital,Xi'an 710100,Shaanxi,CHINA)

机构地区：[1]西安国际医学中心医院神经外科,陕西西安710100

出　　处：《海南医学》2022年第11期1414-1417,共4页Hainan Medical Journal

基　　金：西安国际医学中心医院院级课题(编号:2020QN012)。

摘　　要：目的观察经鼻蝶神经内镜垂体瘤切除术治疗垂体瘤的效果,并探讨其对患者应激反应和视觉功能的影响。方法将西安国际医学中心医院神经外科2019年2月至2020年4月收治的76例垂体瘤患者依据随机数表法分为观察组和对照组,每组38例。对照组患者实施传统开颅术,观察组患者实施经鼻蝶神经内镜垂体瘤切除术。比较两组患者围术期指标(手术时间、术中出血量、住院时间)、术中应激指标[血管紧张素Ⅱ(AngⅡ)、血管紧张素原酶(R)、去甲肾上腺素(NE)]水平、术前及术后1个月视觉功能[视野指数(VFI)、视野平均缺损(MD)值、视野模式标准差(PSD)]变化、术后肿瘤切除率及并发症发生情况。结果观察组患者的治疗总有效率为92.10%,明显高于对照组的73.68%,差异具有统计学意义(P<0.05);观察组患者的手术时间、术中出血量、住院时间分别为(86.25±6.69)min、(76.39±6.26)mL、(8.17±2.54)d,明显短(少)于对照组的(89.09±5.13)min、(80.16±6.63)mL、(10.16±2.37)d,差异均有统计学意义(P<0.05);术中观察组患者的AngⅡ、R、NE水平明显低于对照组,差异均具有统计学意义(P<0.05);术后1个月,观察组患者的VFI和MD分别为(90.34±5.17)%、(-3.03±2.06)dB,明显高于对照组的(83.21±7.14)%、(-5.29±2.14)dB,PSD为(3.01±0.46)dB,明显低于对照组的(3.97±0.52)dB,差异均有统计学意义(P<0.05);观察组患者的肿瘤切除率为89.47%,明显高于对照组的71.05%,并发症总发生率为7.89%,明显低于对照组的26.32%,差异均有统计学意义(P<0.05)。结论经鼻蝶神经内镜垂体瘤切除术治疗垂体瘤患者疗效显著,其不仅可有效改善患者的围术期指标,减轻应激反应,改善视觉功能,且可提高肿瘤切除率,并减少术后并发症,更有利于患者恢复。Objective To observe the clinical efficacy of transsphenoidal endoscopic pituitary tumor resection for pituitary tumor,and to investigate its effects on stress response and visual function of patients.Methods A total of76 patients with pituitary tumor admitted to Department of Neurosurgery,Xi’an International Medical Center Hospital from February 2019 to April 2020 were divided into an observation group and a control group according to random number table method,with 38 patients in each group.Patients in the control group received traditional craniotomy,and patients in the observation group received transsphenoidal endoscopic pituitary tumor resection.Perioperative indicators(operation time,intraoperative blood loss,length of hospital stay),intraoperative stress index[angiotensin Ⅱ(AngⅡ),angiotensin enzyme(R),norepinephrine(NE)]level,visual function before and 1 month after surgery[view index(VFI),mean defect(MD)value view,view pattern standard deviation(PSD)],tumor resection rate,and complications compared between the two groups.Results The operative time,intraoperative blood loss,and length of hospital stay of the observation group were(86.25±6.69)min,(76.39±6.26)mL,(8.17±2.54)d,respectively,significantly shorter(less)than(89.09±5.13)min,(80.16±6.63)mL,(10.16±2.37)d in the control group(P<0.05).Intraoperative AngⅡ,R,and NE levels in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).One month after surgery,VFI and MD of the observation group were(90.34±5.17)% and(-3.03±2.06)d B,respectively,significantly higher than(83.21±7.14)% and(-5.29±2.14)dB of the control group,and PSD was(3.01±0.46)dB,significantly lower than(3.97±0.52)d B in the control group,all with statistically significant differences(P<0.05).The tumor resection rate of the observation group was 89.47%,which was significantly higher than71.05% of the control group,and the total incidence of complications was 7.89%,which was significantly lower than 26.

关 键 词：垂体瘤 经鼻蝶神经内镜垂体瘤切除术 应激反应 视觉功能 肿瘤切除率 并发症 

分 类 号：R739.41[医药卫生—肿瘤]