神经内镜下经鼻蝶窦入路与开颅入路对复杂性颅咽管瘤患者手术效果、血清垂体激素水平及并发症的影响  

Effect of neuroendoscopic transnasal sphenoidal approach versus cranial approach on surgical outcomes,serum pituitary hormone levels and complications in patients with complex craniopharyngiomas

作　　者：卜雄建 陈雪飞 张春良 张颖 吴莉莉[1] BU Xiongjian;CHEN Xuefei;ZHANG Chunliang;ZHANG Ying;WU Lili(Department of Neurosurgery,Baoding Second Central Hospital,Baoding,Hebei 072750,China)

机构地区：[1]河北省保定市第二中心医院神经外科,河北保定072750

出　　处：《检验医学与临床》2024年第21期3205-3209,共5页Laboratory Medicine and Clinic

基　　金：河北省保定市科技计划项目(2241ZF198)。

摘　　要：目的对比分析神经内镜下经鼻蝶窦入路与开颅入路治疗复杂性颅咽管瘤(CCP)的手术疗效,以及对患者血清垂体激素水平和并发症的影响。方法选择该院2017年12月至2022年12月收治的90例CCP患者作为研究对象,按随机数字表法分为观察者和对照组,每组45例。观察组患者行神经内镜下经鼻蝶窦入路颅咽管瘤切除术治疗,对照组患者行开颅入路颅咽管瘤切除术治疗。比较两组手术情况(手术时间、肿瘤切除时间、术中出血量及住院时间),主要临床症状缓解情况(视力下降或伴视野损害缓解率、头痛或头晕的缓解率),以及肿瘤切除情况。分别于术前和术后3 d检测患者血清垂体激素[促肾上腺皮质激素(ACTH)、促甲状腺激素(TSH)及生长激素(GH)]水平。比较两组术后并发症发生情况。结果两组手术时间、肿瘤切除时间、术中出血量比较,差异均无统计学意义(P>0.05);观察组住院时间明显长于对照组(P<0.05)。观察组肿瘤全切率为71.11%,明显高于对照组的46.67%(P<0.05)。观察组术后视力下降或伴视野损害、头痛或头晕的缓解率分别为73.33%、60.00%,明显高于对照组的53.33%、37.78%(P<0.05)。术后3 d,两组血清ACTH、TSH、GH水平均较术前明显降低(P<0.05);术后3 d,观察组血清ACTH、TSH、GH水平均明显高于对照组(P<0.05)。观察组尿崩症、腺垂体功能减退、脑神经损伤的发生率分别为22.22%、33.33%、0,明显低于对照组的46.67%、62.22%、13.33%(P<0.05)。观察组脑脊液漏发生率为13.33%,明显高于对照组的0(P<0.05)。结论神经内镜下经鼻蝶窦入路相对于开颅入路治疗CCP的肿瘤全切率更高,对患者血清垂体激素水平的影响更小,尿崩症、腺垂体功能减退、脑神经损伤等手术相关并发症的发生率更低。Objective To compare the surgical efficacy of neuroendoscopic transnasal sphenoidal approach versus cranial approach in the treatment of complex craniopharyngiomas(CCP)and to evaluate their impact on serum pituitary hormone levels and complications in patients.Methods A total of 90 patients with CCP admitted to the hospital from December 2017 to December 2022 were selected as the study subjects,which were divided into the observation group and the control group according to the randomized numerical table method,with 45 cases in each group.Patients in the observation group were treated with neuroendoscopic transnasal sphenoidal approach craniopharyngioma resection,and patients in the control group were treated with cranial approach craniopharyngioma resection.The two groups were compared in terms of surgical parameters(operation time,tumor resection time,intraoperative blood loss and hospitalization time),relief of major clinical symptoms(the relief rates of visual loss or with visual field damage,the relief rates of headache or dizziness)and tumor resection outcomes.Serum pituitary hormone levels[adrenocorticotropic hormone(ACTH),thyroid-stimulating hormone(TSH)and growth hormone(GH)]were measured preoperatively and 3 d postoperatively,respectively.Postoperative complications were also compared between the two groups.Results There were no significant differences in operation time,tumor resection time and intraoperative blood loss between the two groups(P>0.05).The hospitalization time of the observation group was significantly longer than that of the control group(P<0.05).The total tumor resection rate in the observation group was 71.11%,which was significantly higher than 46.67%in the control group(P<0.05).The relief rates of postoperative visual loss or with visual field damage,headache or dizziness in the observation group were 73.33%and 60.00%,respectively,which were significantly higher than 53.33%and 37.78%in the control group(P<0.05).At 3 d postoperatively,the serum ACTH,TSH and GH levels of both groups we

关 键 词：神经内镜 经鼻蝶窦入路 开颅入路 颅咽管瘤 垂体激素 肿瘤切除 

分 类 号：R739.41[医药卫生—肿瘤] R446.1[医药卫生—临床医学]