显微镜及神经内镜经鼻蝶窦手术治疗垂体瘤的对比研究  

Comparative study of microscopic and endoscopic transsphenoidal surgery for pituitary adenoma

作　　者：赵浥 王希[2] 魏栋[2] 陈功[2] 李立新[2] ZHAO Yi;WANG Xi;WEI Dong(The First Clinical Medical College,Nanjing Medical University,Nanjing 211166,China)

机构地区：[1]南京医科大学第一临床医学院,南京211166 [2]南京医科大学第一附属医院神经外科

出　　处：《临床神经外科杂志》2022年第5期538-542,共5页Journal of Clinical Neurosurgery

基　　金：国家自然科学基金面上项目(81171147);江苏省科教强卫工程医学重点人才研究基金(ZDRCA2016010)。

摘　　要：目的 对比显微镜经鼻蝶手术与神经内镜经鼻蝶手术治疗垂体瘤的治疗效果。方法 选取江苏省人民医院自2019年1月—2020年11月收治并接受手术治疗的垂体瘤患者共计114例,按手术方法的不同分为观察组(n=69)和对照组(n=45)。观察组应用经鼻蝶神经内镜垂体瘤切除术,对照组则应用经鼻蝶显微镜垂体瘤切除术。术后比较两组之间的肿瘤全切除率、手术前后激素水平下降程度、原发症状改善情况以及并发症。结果 对照组手术时间明显少于观察组(P <0.05),术中出血量和术后住院时间两组间无明显差异(P>0.05);观察组手术全切率高于对照组,但差异无统计学意义(P> 0.05);观察组肿瘤术后出现并发症率(5.8%)略低于对照组(6.7%),差异有统计学意义(P <0.05);观察组术后原发症状改善率(92.7%)高于对照组(80.0%),差异有统计学意义。手术后,两组内泌乳素、生长激素均低于手术前(P <0.05),而促肾上腺皮质激素术后较术前平均值两组均降低,但因样本略少,差异无统计学意义(P> 0.05);两组间术后泌乳素、生长激素和促肾上腺皮质激素水平无统计学意义(P> 0.05)。结论 对于垂体瘤患者,神经内镜经鼻蝶手术治疗效果较显微镜经鼻蝶手术治疗效果要更好,在全切除率、激素下降水平与显微镜手术相仿的同时,可减少术后并发症发生率,且原发症状改善率较显微镜手术高,值得在临床中推广应用。Objective To compare the therapeutic effects of microscopic and endoscopic transsphenoidal surgery for pituitary tumors.Methods A total of 114 cases of pituitary tumors treated surgically in Jiangsu Province Hospital from January 2019 to November 2020 were divided into an observation group(n=69)and a control group(n=45)according to the different surgical methods.Transsphenoidal neuroendoscopic pituitary tumor resection was performed in the observation group,while transsphenoidal microscopic pituitary tumor resection was performed in the control group.The total tumor resection rate,the degree of decrease in hormone levels before and after the operation,the improvement of primary symptoms and complications were compared between the two groups after operation.Results The operation time of the control group was significantly shorter than that of the observation group(P<0.05).There was no significant difference in intraoperative blood loss and postoperative hospital stay between the two groups(P>0.05).The total surgical resection rate in the observation group was higher than that in the control group,but the difference was not statistically significant(P>0.05).The complication rate after tumor surgery in the observation group(5.8%)was slightly lower than that in the control group(6.7%),and the difference was statistically significant(P<0.05).The improvement rate of postoperative primary symptoms in the observation group was 92.7%,which was higher than that in the control group(80%).The difference between the two groups was statistically significant.After surgery,prolactin and growth hormone levels in the two groups were lower than those before surgery(P<0.05),while adrenocorticotropic hormone levels after surgery were lower than the preoperative average values in both groups.However,due to the small sample size,the difference was not statistically significant(P>0.05).There was no significant difference in the levels of prolactin,growth hormone and adrenocorticotropic hormone after surgery between the two groups(P>0.05

关 键 词：经鼻蝶显微镜垂体瘤切除术 经鼻蝶神经内镜垂体瘤切除术 垂体瘤 

分 类 号：R739.41[医药卫生—肿瘤] R651.1[医药卫生—临床医学]