多模态神经导航在经鼻蝶垂体腺瘤切除手术中的应用效果  

Effect of application of multimodal navigation in transnasal transsphenoidal resection of pituitary adenoma

作　　者：林国中 杨军 马长城 陈素华 韩芸峰 杨辰龙 孙建军 于涛 吴超 陈新 Lin Guozhong;Yang Jun;Ma Changcheng;Chen Suhua;Han Yunfeng;Yang Chenlong;Sun Jianjun;Yu Tao;Wu Chao;Chen Xin(Department of Neurosurgery,Peking University Third Hospital,Center for Precision Neurosurgery and Oncology,Peking University Health Science Center,Bejing 100191,China)

机构地区：[1]北京大学第三医院神经外科,北京大学医学部精准神经外科与肿瘤研究中心,北京100191

出　　处：《中华神经外科杂志》2023年第6期567-571,共5页Chinese Journal of Neurosurgery

基　　金：首都临床特色应用研究(Z161100000516109);北京大学临床科学家计划专项(BMU2019LCKXJ007);北京大学第三医院临床重点项目(BYSY2018060)。

摘　　要：目的探讨多模态神经导航在经鼻蝶垂体腺瘤切除手术中的应用效果.方法回顾性分析2019年6月至2022年5月北京大学第三医院神经外科采用神经导航下经鼻蝶入路肿瘤切除术治疗的138例垂体腺瘤患者(导航组)的临床资料,以2018年1月至2019年5月采用经鼻蝶入路肿瘤切除术治疗的48例垂体腺瘤患者作为对照组.两组患者的年龄、性别等基线资料的差异均无统计学意义(均P>0.05).对比分析两组患者的疗效及并发症发生率等.结果与对照组比较,导航组蝶窦开口识别率[分别为100%(138/138)、91.7%(44/48)]、视神经沟和颈动脉压迹识别率[分别为100%(138/138)、83.3%(40/48)]均更高,手术时间更短[分别为(67.0±13.2)min、(85.6±18.2)min],术中出血量更少[M(Q1,Q3)分别为15(15,20)ml、30(15,40)ml],差异均具有统计学意义(均P<0.05).导航组与对照组术后脑脊液漏[分别为2.9%(4/138)、6.3%(3/48)]、短暂性尿崩[分别为4.3%(6/138)、8.3%(4/48)]发生率的差异均无统计学意义(均P>0.05).导航组与对照组患者肿瘤全切除率的差异无统计学意义[分别为93.5%(129/138)、87.5%(42/48),χ^(2)=1.72,P=0.190].所有患者均获得临床随访,导航组的随访时间较对照组短[(10.1±5.6)个月、(22.6±6.9)个月,t=-12.55,P<0.001].随访期间,两组患者的临床症状均有不同程度的改善,且无激素水平低下者;导航组与对照组患者肿瘤复发率的差异无统计学意义[分别为0、4.2%(2/48),P=0.066].结论经鼻蝶垂体腺瘤切除术中应用多模态神经导航有助于辨识解剖学结构,减少手术创伤,缩短手术时间.Objective To explore the effect of multimodal navigation in transnasal transsphenoidal(TNTS)resection of pituitary adenoma.Methods A retrospective analysis was conducted on the clinical data of 138 patients of pituitary adenoma who underwent TNTS resection of tumor with the assistance of multimodal navigation(navigation group)in the Department of Neurosurgery,Peking University Third Hospital from June 2019 to May 2020.The 48 pituitary adenoma patients who were treated with TNTS tumor resection from January 2018 to May 2019 in the same hospital were selected as control group.There was no statistically significant difference in baseline data such as age and gender between the two groups of patients(P>0.05).The efficacy and ineidence of complications were analyzed and compared between the two groups.Results Compared with the control group,the recognition rates of sphenoid sinus opening[100%(138/138)rs.91.7%(44/48)respectively]and optic neural groove and carotid artery compression[100%(138/138)vs.83.3%(40/48)]in the navigation group were higher,the operation time was shorter(67.0±13.2 min us.85.6±18.2 min),and the intraoperative bleeding was less[M(Qi,Q3):15(15,20)mlus.30(15,40)ml],and the differences were statistically significant(all P<0.05).There was no statistically significant difference in the incidence of postoperative cerebrospinal fluid leakage[2.9%(4/138)us.6.3%(3/48)]or transient diabetes insipidus[4.3%(6/138)rs.8.3%(4/48)]between the navigation group and control group(bothP>0.05).There was no statistically significant difference in total tumor resection rate between the navigation group and control group[93.5%(129/138)us.87.5%(42/48),χ^(2)=1.72,P=0.190].All patients received clinical follow-up,and the follow-up time in the navigation group was shorter than that in the control group(10.1±5.6 months us.22.6±6.9 months,t=-12.55,P<0.001).During the follow-up period,the clinical symptoms of both groups improved to varying degrees and there were no patients with low hormone levels.The difference n tumor re

关 键 词：垂体肿瘤 神经导航 多模态成像 显微外科手术 治疗结果 经鼻蝶入路 

分 类 号：R736.4[医药卫生—肿瘤]