神经内镜与显微镜经鼻蝶手术治疗复发垂体腺瘤效果比较  

Comparison of the clinical effects between neuroendoscopy and microscopic transsphenoidal surgery in treatment of recurrent pituitary adenomas

作　　者：胡长伟[1] 王希瑞[1] 李亚斌[1] 韩晓勇[1] 任宝文[1] 尹港峰[1] HU Changwei;WANG Xirui;LI Yabin(Department of Neurosurgery,Cangzhou Central Hospital,Hebei,Cangzhou 061000,China)

机构地区：[1]河北省沧州市中心医院神经外科,061000

出　　处：《河北医药》2022年第16期2439-2442,共4页Hebei Medical Journal

基　　金：河北省卫健委青年科技课题(编号:20200339)。

摘　　要：目的比较神经内镜与显微镜不同手术方式在经鼻蝶手术治疗复发垂体腺瘤中的疗效。方法回顾性分析2014至2019年经鼻蝶入路手术治疗的复发垂体腺瘤患者48例。显微镜手术组23例,神经内镜手术组25例。比较2组患者手术时间,肿瘤切除程度,平均住院时间,术后症状缓解,术后并发症(脑脊液鼻漏、垂体功能低下、术区出血),术后2年再复发率。结果显微镜治疗组手术时间(99.78±26.26)min,较神经内镜治疗组(172.40±43.83)min用时短(P<0.05);术后症状缓解与术后并发症比较,2组差异无统计学意义(P>0.05);显微镜治疗组肿瘤切除程度明显低于神经内镜治疗组(Z=-2.14,P=0.03);神经内镜治疗组平均住院时间(12.12±0.88)d和术后2年复发率(16%)明显低于显微镜治疗组的(15.83±1.20)d和43.48%(t=2.54,P=0.01;χ2=4.38,P=0.04)。结论在经鼻蝶入路手术治疗复发垂体腺瘤方面,应用神经内镜虽然比显微镜手术时间长,但神经内镜可在不升高术后并发症率和不减少术后症状缓解率的同时,减少住院时间,增加肿瘤切除率,降低术后2年肿瘤复发率。Objective To compre the clinical effects between neuroendoscopy and microscopic transsphenoidal surgery in treatment of recurrent pituitary adenomas.Methods The clinical data about 48 patients with recurrent pituitary adenoma who were treated by transnasal transsphenoidal approach surgery in our hospital from 2014 to 2019 were retrospectively analyzed,of whom,there were 23 cases in microscope operation group and 25 cases in neuroendoscopic operation group.The operation time,tumor resection degree,average hospital stay,postoperative symptom relief,postoperative complications(cerebrospinal fluid rhinorrhea,hypophysis,bleeding in the operation area)and recurrence rate at 2 years after operation were observed and compared between the two groups.Results The operation time in microscope operation group was(99.78±26.26)min,which was significantly shorter than that[(172.40±43.83)min]in neuroendoscopic operation group(P<0.05).There were no significant differences in postoperative symptom relief and postoperative complications between the two groups(P>0.05).The degree of tumor resection in microscope treatment group was significantly lower than that in neuroendoscopic treatment group(P<0.05).The average length of hospital stay(12.12±0.88)days and 2-year recurrence rate(16%)in neuroendoscopic treatment group were significantly lower than those(15.83±1.20)days and(43.48%)in microscopic treatment group(P<0.05).Conclusion In the treatment of recurrent pituitary adenomas by transnasal transsphenoidal approach,the application of neuroendoscopy can reduce the length of hospital stay,increase the tumor resection rate and reduce the 2-year recurrence rate without increasing the incidence of postoperative complications and reducing the postoperative symptom relief rate.

关 键 词：复发垂体腺瘤 神经内镜 显微镜 疗效 

分 类 号：R736.4[医药卫生—肿瘤]