眶上外侧入路联合神经导航系统辅助神经内镜经鼻蝶入路治疗老年巨大侵袭性垂体腺瘤的效果分析  

Effect analysis of combined lateral orbitozygomatic approach with neuronavigation-assisted endoscopic endonasal transsphenoidal approach in the treatment of elderly patients with giant invasive pituitary adenoma

作　　者：张龙[1] 杨大为[1] 揣瑞宇 王桂林 ZHANG Long;YANG Da-wei;CHUAI Rui-yu(Department of Neurosurgery,Qinhuangdao First Hospital,Qinhuangdao Hebei 066000,China)

机构地区：[1]秦皇岛市第一医院神经外科,河北秦皇岛066000

出　　处：《临床和实验医学杂志》2024年第22期2450-2454,共5页Journal of Clinical and Experimental Medicine

基　　金：河北省自然科学基金资助项目(编号:H2022207219)。

摘　　要：目的分析眶上外侧入路联合神经导航系统辅助神经内镜经鼻蝶入路治疗老年巨大侵袭性垂体腺瘤的效果。方法将2019年2月至2021年12月在秦皇岛市第一医院就诊的老年巨大侵袭性垂体腺瘤75例的临床资料进行回顾性分析,以手术方法不同将其分为对照组(n=37)、观察组(n=38)。对照组采用神经导航系统辅助神经内镜经鼻蝶入路治疗,观察组采用神经导航系统辅助神经内镜经鼻蝶入路联合眶上外侧入路治疗。对比两组手术一般情况、肿瘤切除情况、日常生活能力[改良巴氏指数(MBI)量表]、内分泌激素[催乳素、促肾上腺皮质激素(ACTH)、生长激素]水平、并发症,随访2年,记录两组生存情况。结果观察组的术中出血量为(116.42±12.53)mL,高于对照组[(92.15±9.32)mL],手术时间为(75.83±9.12)min,长于对照组[(66.47±7.26)min],术后住院时间为(7.14±1.76)d,短于对照组[(12.57±2.85)d],差异均有统计学意义(P<0.05)。观察组肿瘤切除率为94.74%,高于对照组(78.38%),差异有统计学意义(P<0.05)。术后3个月,两组MBI评分均较术前升高,且观察组MBI评分为(82.45±3.12)分,高于对照组[(67.38±4.23)分],差异均有统计学意义(P<0.05)。术后1周,两组催乳素、ACTH、生长激素水平均较术前降低,且观察组催乳素、ACTH、生长激素水平分别为(132.09±14.52)、(33.39±5.28)、(10.33±1.94)μg/L,均低于对照组[(154.36±16.87)、(42.04±8.30)、(14.68±3.29)μg/L],差异均有统计学意义(P<0.05)。观察组总并发症发生率为10.53%,低于对照组(29.73%),差异有统计学意义(P<0.05)。两组无瘤生存时间、总生存时间比较差异均无统计学意义(P>0.05)。结论老年巨大侵袭性垂体腺瘤患者采用眶上外侧入路联合神经导航系统辅助神经内镜经鼻蝶入路治疗效果显著,可提高肿瘤切除率,改善患者生活质量及内分泌激素水平,降低并发症发生风险。Objective To analyze the efficacy of combined lateral orbitozygomatic approach with neuronavigation-assisted endoscopic endonasal transsphenoidal approach in the treatment of elderly patients with giant invasive pituitary adenoma.Methods The clinical data of 75 elderly patients with giant invasive pituitary adenoma treated in the Qinhuangdao First Hospital from February 2019 to December 2021 were retrospectively analyzed,and they were divided into the control group(n=37)and the observation group(n=38)according to the different surgical methods.The control group was treated with neuronavigation system assisted neuroendoscope transnasal sphenoidal approach,and the observation group was treated with neuronavigation system assisted neuroendoscope transnasal sphenoidal approach combined with supraorbital lateral approach.The general conditions of operation,tumor resection,daily living ability[modified Barthel index(MBI)scale],endocrine hormone[prolactin,adrenocorticotropic hormone(ACTH),growth hormone]level and complications of the two groups were compared.The survival of the two groups was recorded after a follow-up of 2 years.Results The intraoperative blood loss of the observation group was(116.42±12.53)mL,which was higher than that of the control group[(92.15±9.32)mL],the operation time was(75.83±9.12)min,which was longer than that of the control group[(66.47±7.26)min],the postoperative hospital stay was(7.14±1.76)d,which was shorter than that of the control group[(12.57±2.85)d],the differences were statistically significant(P<0.05).The tumor resection rate of the observation group was 94.74%,which was higher than that of the control group(78.38%),and the difference was statistically significant(P<0.05).At 3 months after operation,the MBI scores of the two groups were higher than those before operation,and the MBI score of the observation group was(82.45±3.12)points,which was higher than that of the control group[(67.38±4.23)points],the differences were statistically significant(P<0.05).One week after oper

关 键 词：神经导航系统 神经内镜 经鼻蝶入路 眶上外侧入路 老年 巨大侵袭性垂体腺瘤 并发症 

分 类 号：R736.4[医药卫生—肿瘤]