数字化三维重建模型在经鼻蝶垂体瘤显微切除术中的应用  

Application of digital 3D reconstruction model in transsphenoidal microsurgery for pituitary tumors

作　　者：买吾拉江·阿木提 买买提艾力·吐尔逊[1] 阿力木·曼素尔 赵贵芹 刘正清[1] Mai Wulajiang·Amuti;Maimaitiaili·Tuerxun;Alimu·Mansuer;Zhao Guiqin;Liu Zhengqing(Department of Neurosurgery,First People's Hospital of Kashi Prefecture,Kashi 844000,China)

机构地区：[1]喀什地区第一人民医院神经外科,喀什844000

出　　处：《中华神经医学杂志》2022年第7期691-696,共6页Chinese Journal of Neuromedicine

基　　金：喀什地区应用技术研究与开发计划项目(KS2020004)。

摘　　要：目的探讨数字化三维重建模型在经鼻蝶垂体瘤显微切除术中的临床应用价值。方法选择喀什地区第一人民医院神经外科自2020年7月至2022年3月收治的58例垂体瘤患者进入研究,所有患者均接受显微镜下经鼻蝶垂体瘤切除术治疗并按照随机数字表法分为对照组(不构建三维模型)及模型组(通过CTA等资料构建三维模型)。比较2组患者肿瘤大小、手术持续时间、术中出血量、手术切除程度、术前术后激素水平及随访3个月时术后并发症情况。结果2组患者年龄、性别分布,肿瘤类型,肿瘤大小及Knosp分级等一般资料差异均无统计学意义(P>0.05),具有可比性。模型组患者垂体瘤切除程度优于对照组,全切和次全切患者所占比例明显高于对照组(24/29 vs.16/29),差异有统计学意义(P=0.045);模型组患者手术时间、术中出血量、住院时间均少于对照组,差异均有统计学意义(P<0.05),其中模型组肿瘤切除时间为(46.93±10.77)min,明显少于对照组[(56.00±12.47)min],差异有统计学意义(P<0.05)。模型组患者术后1 d和术后7 d的血清泌乳素(PRL)和生长激素(GH)水平均低于对照组,但差异无统计学意义(P>0.05)。随访3个月时,模型组患者尿崩症、低钠血症、垂体功能减退发生率明显低于对照组,差异有统计学意义(P<0.05)。模型组患者满意度优于对照组患者,差异有统计学意义(P<0.05)。结论垂体瘤数字化三维重建模型有助于术前了解肿瘤与神经、血管的毗邻关系,制定个性化手术方案并提高手术效率。Objective To investigate the clinical value of digital three-dimensional reconstruction model of pituitary adenoma in transsphenoidal endoscopic pituitary adenoma resection.Methods Fifty-eight patients with endoscopic pituitary,admitted to our hospital from July 2020 to March 2022,were chosen.All patients accepted transsphenoidal surgery under microscope and were randomly assigned to a control group(without digital 3D reconstruction technology before surgery)and a model group(with digital 3D reconstruction technology before surgery).The tumor size,preoperative and postoperative hormone levels,surgical duration,intraoperative blood loss,extent of surgical resection,and complications 3 months after follow up were compared.Results There was no significant difference in age,gender,tumor types,tumor sizes and Knosp grading between the two groups(P>0.05),indicating comparability.The resection degree of pituitary tumor in model group was better than that that in control group;the proportion of patients with total and subtotal resection in the model group was significantly higher than that in the control group(24/29 vs.16/29,P=0.045).Intraoperative blood loss,surgical duration and average hospital stay in the model group were significantly decreased as compared those in the control group(P<0.05);the duration of tumor resection in the model group([46.93±10.77]min)was significantly shorter than that in the control group([56.00±12.47]min,P<0.05).The levels of prolactin and human growth hormone in the model group 1 and 7 d after surgery were decreased as compared with those in the control group,without significant differences(P>0.05).Three months after follow-up,the incidences of diabetes insipidus,hyponatremia and hypopituitarism in model group were significantly lower than those in control group(P<0.05).The satisfaction rate in the model group was significantly higher than that in the control group(P<0.05).Conclusion The construction of digital three-dimensional reconstruction model of pituitary adenoma is helpful in und

关 键 词：垂体瘤 数字化三维重建 经鼻蝶垂体瘤切除术 显微外科手术 

分 类 号：R736.4[医药卫生—肿瘤]