神经内镜下经鼻蝶窦扩大鞍底入路颅咽管瘤切除术的疗效分析  

Efficacy and impact on stress response and inflammation levels of craniopharyngiomas through endoscopic endonasal transsphenoidal approach

作　　者：陈雪飞 卜雄建 张春良 Xuefei Chen;Xiongjian Bu;Chunliang Zhang(Department of Neurosurgery,Baoding Second Central Hospital,Baoding 072750,China)

机构地区：[1]保定市第二中心医院神经外科,河北保定072750

出　　处：《中华脑科疾病与康复杂志(电子版)》2024年第3期160-165,共6页Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition)

基　　金：保定市科技计划项目(2241ZF198)

摘　　要：目的研究神经内镜下经鼻蝶窦扩大鞍底入路颅咽管瘤切除术治疗颅咽管瘤的疗效及对应激反应、炎症水平的影响。方法前瞻性选择保定市第二中心医院神经外科自2020年11月至2022年11月收治的92例颅咽管瘤患者为研究对象,采用中央随机系统将患者分为研究组(46例)和对照组(46例)。对照组采用开颅入路,研究组采用神经内镜下经鼻蝶窦扩大鞍底入路。分析2组患者的手术情况(包括手术时长、出血量及住院时间等)、应激反应指标、炎症水平、肿瘤切除情况以及术后并发症发生情况等。结果研究组患者的手术时长和出血量与对照组比较,差异无统计学意义(P>0.05);但住院时间少于对照组,差异有统计学意义(P<0.05)。研究组患者的手术全切率(47.83%)及随访3个月的临床症状缓解率(86.96%)高于对照组(34.78%、47.83%),差异均有统计学意义(P<0.05)。研究组患者术后的肾上腺素、去甲肾上腺素、皮质醇、C反应蛋白、白介素-1β、单核细胞趋化蛋白、白介素-8和肿瘤坏死因子-α水平均低于术前,且低于对照组,差异均有统计学意义(P<0.05)。研究组患者并发症发生率(13.04%)低于对照组(30.43%),差异有统计学意义(P<0.05)。结论相较于传统的开颅手术,神经内镜下经鼻蝶窦扩大鞍底入路颅咽管瘤切除术可以提高肿瘤全切率,改善手术效果,降低应激反应及炎症水平,减少并发症的发生率。Objective To study the efficacy of neuroendoscopy-assisted transnasal transsphenoidal expanded approach for craniopharyngioma resection in treating craniopharyngioma and its impact on stress response and inflammatory levels.Methods A total of 92 patients with craniopharyngioma admitted to the Neurosurgery Department of Baoding Second Central Hospital from November 2020 to November 2022 were selected as the study objects.The patients were divided into the study group(46 cases)and the control group(46 cases)by a central randomized system.The control group was treated with craniotomy approach,and the study group was treated with expanded transnasal transsphenoidal approach under neuroendoscopy.The operation conditions(including operation duration,blood loss and hospital stay,etc.),stress response indexes,inflammation level,tumor resection and postoperative complications of the two groups were analyzed.Results There was no significant difference in operation duration and blood loss between the study group and the control group(P>0.05).However,the hospitalization time of the study group was less than that of the control group(P<0.05).The total resection rate(47.83%)and the remission rate of clinical symptoms after 3 months of follow-up(86.96%)of the study group were higher than those of the control group(34.78%,47.83%)(P<0.05).The postoperative levels of epinephrine,norepinephrine,cortisol,C-reactive protein,interleukin-1β,monocyte chemotactic protein,interleukin-8 and tumor necrosis factor-αin the study group were lower than those before surgery,and lower than those in the control group(P<0.05).The complication rate of the study group(13.04%)was lower than that of the control group(30.43%,P<0.05).Conclusion Compared with the traditional craniotomy,the craniopharyngioma resection through transnasal endoscopic expanded sellar approach under neuroendoscope can increase the total resection rate of the tumor,improve the surgical outcome,reduce the level of stress response and inflammation,and reduce the incidence of com

关 键 词：神经内镜下经鼻蝶窦扩大鞍底入路 颅咽管瘤 应激反应 炎症反应 

分 类 号：R739.4[医药卫生—肿瘤]