显微镜术和神经内镜下经鼻蝶窦入路切除术治疗垂体瘤的疗效对比  

Comparison of the effect of microscopic and neuroendoscopic sphenoidal sinus resection for pituitary tumor

作　　者：王向红 王瑞娟 杨立昌 赵亚莉 朱荣 WANG Xianghong;WANG Ruijuan;YANG Lichang;ZHAO Yali;ZHU Rong(The 940th Hospital of China People's Liberation Army Joint Logistics Support Force,Lanzhou 730070,China)

机构地区：[1]中国人民解放军联勤保障部队第九四〇医院,甘肃兰州730070

出　　处：《中国实用神经疾病杂志》2023年第7期875-880,共6页Chinese Journal of Practical Nervous Diseases

摘　　要：目的分析显微镜术和神经内镜下经鼻蝶窦入路切除术对垂体瘤患者应激反应、性激素的影响及预后的相关因素。方法选取2018-07—2021-02中国人民解放军联勤保障部队第九四〇医院治疗的96例垂体瘤患者为研究对象,分为显微镜组(50例)和神经内镜组(46例),比较显微镜组与神经内镜组患者术前、术后1个月应激指标、性激素水平及并发症发生率、术后2 a复发率。根据随访2 a期间是否复发分为复发组与未复发组,通过单因素与多因素Logistic回归分析影响预后的相关危险因素。结果神经内镜组患者术后1个月的NE、肾上腺素、ATⅡ、PRL、TSH、hGH水平及并发症发生率均低于显微镜组(P<0.05)。2组患者复发率比较差异无统计学意义(P>0.05)。综合单因素与多因素Logistic回归分析,肿瘤直径>3 cm、Hardy分型Ⅳ型、Knosp分级3~4级、非完全切除、未辅助治疗是垂体瘤患者术后复发的独立危险因素(P<0.05)。结论神经内镜下经鼻蝶窦入路切除术相比于显微镜术,能够更有效地平复垂体瘤患者应激反应和性激素水平,并发症更少,但均存在术后复发风险,尤其对于肿瘤直径>3 mm、Hardy分型Ⅳ型、Knosp分级3~4级、非完全切除的高危因素患者,应采取辅助治疗等针对性干预措施。Objective To analyze the effect of microscopic and neuroendoscopic sphenoidal sinus resection on stress response,sex hormones and prognostic factors in patients with pituitary tumor.Methods From July 2018 to February 2021,96 patients with pituitary tumor were selected as study objects,and divided into microscope group(50 cases)and neuroendoscopic group(46 cases).The stress index,sex hormone level,complication rate and recurrence rate of 2 years after surgery were compared between the microscope group and the neuroendoscope group.According to whether relapse occurred during follow-up 2 years,the patients were divided into relapse group and non-recurrence group,the risk factors influencing prognosis were analyzed by univariate and multivariate Logistic regression.Results One month after surgery,NE,adrenaline,AT,PRL,TSH,hGH levels and complication rates in the neuroendoscopic group were all lower than those in the microscope group(P<0.05).There was no significant difference in the recurrence rate between the two groups(P>0.05).Combining univariate and multivariate Logistic regression analysis,tumor diameter>3 cm,Hardy type typeⅣ,Knosp grade 3-4,and non-complete resection were independent risk factors for postoperative recurrence of pituitary tumor(P<0.05).Conclusion Compared with microscopy,neuroendoscopic transnasal sphenoidal approach resection can more effectively calm stress response and sex hormone levels in patients with pituitary tumors,with fewer complications.However,there is a risk of postoperative recurrence,especially for high-risk patients with tumor diameter>3 mm,Hardy classification typeⅣ,Knosp grade 3-4,and incomplete resection.Targeted intervention measures such as adjuvant therapy should be taken.

关 键 词：垂体瘤 显微镜术 神经内镜 鼻蝶窦入路切除术 应激反应 性激素 预后 影响因素 

分 类 号：R736.4[医药卫生—肿瘤]