锁孔入路切除和鼻蝶窦入路切除对脑垂体瘤患者颅内血肿、脑脊液鼻漏发生率的影响  

Effect of Supraorbital Keyhole Approach and Endonasal Transsphenoidal Approach on Intracranial Hematoma and Cerebrospinal Rhinorrhea Rate in Patients with Pituitary

作　　者：石玲红 党帅[1] 陈烈冉[1] 和青森 SHI Linghong;DANG Shuai;CHEN Lieran(Nanyang Central Hospital,Nanyang,473000)

机构地区：[1]河南省南阳市中心医院,473000

出　　处：《实用癌症杂志》2023年第2期283-286,共4页The Practical Journal of Cancer

摘　　要：目的探讨锁孔入路切除和鼻蝶窦入路切除对脑垂体瘤患者颅内血肿、脑脊液鼻漏发生率的影响。方法选取82例脑垂体瘤患者作为研究对象,将其随机分为A组(n=45)和B组(n=37)。其中A组患者行显微镜下锁孔入路切除术,B组患者行神经内镜下鼻蝶窦入路切除术。比较两组患者临床疗效、手术指标、肿瘤全切率和内分泌下降情况以及术后颅内血肿、脑脊液鼻漏发生率。结果治疗后A组治愈19例(42.22%),显效8例(17.78%),有效8例(17.78%),无效10例(22.22%);B组治愈23例(62.16%),显效8例(21.62%),有效4例(10.81%),无效2例(5.41%)。A组有效率(77.78%)低于B组(94.59%)(P<0.05)。A组手术时间(93.42±21.75)min显著长于B组(65.82±17.44)min(P<0.05);住院时间(9.79±1.27)d显著长于B组(6.08±1.16)d(P<0.05);A组术中失血量为(76.71±8.45)ml,显著多于B组(50.62±6.73)ml(P<0.05)。A组中肿瘤全切35例(77.78%),B组全切35例(94.59%);A组出现内分泌激素下降20例(44.44%),B组出现下降25例(67.57%)。A组肿瘤全切率与内分泌激素下降比例均明显低于B组(P<0.05)。A组术后出现颅内血肿和脑脊液鼻漏分别为3例(6.67%)和7例(15.56%),B组出现脑脊液鼻漏2例(5.41%),未出现颅内血肿,A组颅内血肿和脑脊液鼻漏发生率均高于B组,但无明显差异(P>0.05)。结论与锁孔入路切除术相比,鼻蝶窦入路切除垂体瘤对脑垂体瘤患者的疗效更好,能够增加肿瘤全切率,加速患者恢复,且颅内血肿和脑脊液鼻漏发生率明显更低,对患者预后质量价值更高。Objective To investigate the effect of Supraorbital keyhole approach and Endonasal transsphenoidal approach on intracranial hematoma and cerebrospinal rhinorrhea rate in patients with pituitary tumor.Methods 82 patients with pituitary adenoma were randomly divided into group A(n=45)and group B(n=37).Among them,group A underwent keyhole microsurgery and group B patients underwent endoscopic sinus surgery.Clinical efficacy,surgical indexes,total tumor removal rate,endocrine decline,and the incidence of postoperative intracranial hematoma and cerebrospinal fluid rhinorrhea were compared between the 2 groups.Results After treatment,19 cases(42.22%)in group A were cured,8 cases(17.78%)were markedly effective,8 cases(17.78%)were effective,and 10 cases(22.22%)were ineffective;In group B,23 cases were cured(62.16%),8 cases were markedly effective(21.62%),4 cases were effective(10.81%),and 2 cases were ineffective(5.41%).The effective rate of group A(77.78%)was lower than that of group B(94.59%)(P<0.05).The operation time of group A(93.42±21.75)min was significantly longer than that of group B(65.82±17.44)min(P<0.05);The hospitalization time(9.79±1.27)days was significantly longer than that(6.08±1.16)days in group B(P<0.05);The intraoperative blood loss in group A was(76.71±8.45)mL,which was significantly higher than that in group B(50.62±6.73)mL(P<0.05).In group A,35 cases(77.78%)were totally resected,and 35 cases(94.59%)in group B;Endocrine hormone decreased in 20 cases(44.44%)in group A and 25 cases(67.57%)in group B.The total tumor resection rate and the decreasing ratio of endocrine hormones in group A were significantly lower than those in group B(P<0.05).There were 3 cases of intracranial hematoma and 7 cases of cerebrospinal fluid rhinorrhea in group A(6.67%)and 7 cases(15.56%),respectively.There were 2 cases of cerebrospinal fluid rhinorrhea in group B(5.41%),without intracranial hematoma.The incidence of intracranial hematoma and cerebrospinal fluid rhinorrhea in group A was higher than that in group B,but

关 键 词：锁孔入路 脑垂体瘤 鼻蝶窦入路 颅内血肿 脑脊液鼻漏 

分 类 号：R739.41[医药卫生—肿瘤]