摘要
目的:探讨内镜下不同入路切除垂体瘤对患者围术期指标、嗅觉功能恢复和并发症的影响。方法:将91例垂体腺瘤患者根据其手术方案分为A组和B组,A组42例,采用黏膜下经内镜垂体瘤切除术,B组49例,采用传统经鼻内镜垂体瘤切除术。观察两组患者围术期相关指标(手术时间、术中出血量和脑脊液漏发生率、肿瘤切除率、住院时间)、术后嗅觉功能恢复情况、术后并发症发生情况及手术前后激素水平[生长激素(GH)、催乳素(PRL)、促肾上腺皮质激素(ACTH)]变化。结果:A组手术时间和住院时间均短于B组,术中出血量少于B组(均P<0.05)。两组术中脑脊液漏发生率和肿瘤切除率比较无统计学差异(均P>0.05)。两组术后嗅觉阈值较术前均降低(P<0.05),但观察组高于对照组(P<0.05)。A组鼻中隔穿孔和鼻腔出血发生率分别为2%和2%,低于B组的14%和18%(均P<0.05)。两组术后PRL、GH、ACTH水平均较术前降低(均P<0.05),两组间比较无统计学差异(均P>0.05)。结论:神经内镜下垂体瘤切除术在治疗垂体瘤中具有一定的临床疗效,经黏膜下入路较传统入路可有效缩短手术时间和术后住院时间,减少术中出血及术后嗅觉功能的损害,降低术后并发症的发生。
Objective:To explore the effects of endoscopic pituitary tumor resection through different approaches on perioperative indexes,recovery of olfactory function and complications.Methods:A total of 91 patients with pituitary adenoma were divided into group A(42 cases,submucosal endoscopic pituitary tumor resection)and group B(49 cases,traditional transnasal endoscopic pituitary tumor excision)according to different surgical methods.The perioperative related indexes(operation time,intraoperative blood loss,incidence of cerebrospinal fluid leakage,tumor resection rate,hospitalization time),recovery of postoperative olfactory function,occurrence of postoperative complications and changes in levels of hormones[growth hormone(GH),prolactin(PRL),adrenocorticotropic hormone(ACTH)]before and after surgery in both groups were observed.Results:The operation time and hospitalization time in group A were shorter than those in group B,and intraoperative blood loss was less than that in group B(all P<0.05).There was no difference in incidence of intraoperative cerebrospinal fluid leakage and tumor resection rate between the two groups(all P>0.05).After surgery,olfactory thresholds in both groups were decreased,but observation group was higher than control group(all P<0.05).The incidence rates of nasal septal perforation and nasal bleeding in group A were 2%and 2%,lower than 14%and 18%in group B(all P<0.05).After surgery,levels of PRL,GH and ACTH in both groups were decreased(all P<0.05),but there was no significant difference between the two groups(all P>0.05).Conclusion:Neuroendoscopic pituitary tumor resection has certain clinical curative effect on pituitary tumor.Compared with traditional approach,transmucosal approach may effectively shorten operation time and postoperative hospitalization time,reduce intraoperative blood loss,postoperative olfactory function damage and postoperative complications.
作者
孙娴
王培丽
崔圆元
SUN Xian;WANG Peili;CUI Yuanyuan(Department of Neurosurgery,East Hospital of Huashan Hospital,Fudan University,Shanghai 201206,China)
出处
《陕西医学杂志》
CAS
2023年第2期192-195,共4页
Shaanxi Medical Journal
基金
上海市卫生和计划生育委员会重要薄弱学科建设项目()2015ZB0301。
关键词
垂体瘤
黏膜下经内镜垂体瘤切除术
围术期
肿瘤切除率
嗅觉功能
并发症
Pituitary tumor
Submucosal endoscopic pituitary tumor resection
Perioperative period
Tumor resection rate
Olfactory function
Complication
