摘要
目的 探讨内镜与显微镜经鼻蝶入路切除术在垂体腺瘤患者中的应用价值。方法 回顾性收集垂体腺瘤患者122例的临床资料,采取内镜经鼻蝶入路切除术61例,设为内镜组,采取显微镜经鼻蝶入路切除术61例,设为显微镜组。比较2组围手术期指标、相关激素[生长激素(human growth hormone,HGH)、促甲状腺素(thyrotropin,TSH)、泌乳素(prolactin,PRL)]、视觉功能[视野指数(visual field index,VFI)、视野模式标准差(pattern standard deviation,PSD)]、嗅觉功能(嗅觉识别阈)、应激反应[血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)、去甲肾上腺素(norepinephrine,NE)、肾素(renin,R)]、并发症发生情况。结果 内镜组住院时间短于显微镜组,术中出血量少于显微镜组(P<0.05)。2组血清AngⅡ、NE、R水平均呈先升高再降低趋势,内镜组变化幅度小于显微镜组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组PRL、TSH、HGH水平均呈降低趋势,且内镜组低于显微镜组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组PSD呈降低趋势,嗅觉识别阈呈先升高再降低趋势,VFI呈升高趋势,内镜组PSD、嗅觉识别阈低于显微镜组,VFI高于显微镜组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组并发症发生率差异无统计学意义(P>0.05)。结论 与显微镜比较,内镜经鼻蝶入路切除术具有手术创伤小、术后恢复快等优势,有助于促进垂体功能、视觉功能恢复,降低对嗅觉功能的影响,且具有一定安全性。
Objective To explore the application value of endoscopic and microscopic transnasal transsphenoidal surgery for pituitary adenomas.Methods Collected clinical data of 122 patients with pituitary adenomas,61 of whom underwent endoscopic transnasal transsphenoidal resection(the endoscopic group),and 61 of whom underwent microscopic transnasal transsphenoidal resection(the microscopic group).The perioperative indicators,relevant hormones [human growth hormone(HGH),thyrotropin(TSH),prolactin(PRL)],visual function [visual field index(VFI),pattern standard deviation(PSD)],olfactory function(olfactory recognition threshold),stress response [angiotensin Ⅱ(Ang Ⅱ),norepinephrine(NE),renin(R)],and complications were compared between two groups.Results The length of hospitalization in the endoscopic group was shorter than that in the microscopic group,and the intraoperative blood loss was less than that in the microscopic group(P<0.05).The levels of serum AngⅡ,NE,and R in both groups showed a trend of first increasing and then decreasing,with a smaller change in the endoscopic group than in the microscopic group,and the differences in interaction between groups,time oints and time points between groups were statistically significant(P<0.05).The levels of PRL,TSH,and HGH in both groups showed a decreasing trend,which were lower in the endoscopic group than in the microscopic group,and the differences in interaction between groups,time points and time points between groups were statistically significant(P<0.05).The PSD in both groups showed a decreasing trend,and the olfactory recognition threshold showed a trend of first increasing and then decreasing.The VFI showed an increasing trend,and the PSD and olfactory recognition threshold in the endoscopic group were lower than those in the microscopic group,while the VFI was higher;the differences in the interaction between groups,time points and time points between groups were statistically significant(P<0.05).The difference in the incidence of complications between two groups was not statistically significant(P>0.05).Conclusion Compared with microscopy,endoscopic transnasal transsphenoidal approach has the advantages of minimal surgical trauma and rapid postoperative recovery,which helps to promote the recovery of pituitary function and visual function,reduce the impact on olfactory function,and has certain safety.
作者
牛国栋
袁明智
孙青青
吴锋
申桃瑞
任洪波
NIU Guo-dong;YUAN Ming-zhi;SUN Qing-qing;WU Feng;SHEN Tao-rui;REN Hong-bo(The Third Department of Neurosurgery,Handan Central Hospital,Hebei Province,Hebei Province,Handan 056002,China)
出处
《河北医科大学学报》
CAS
2024年第1期101-106,共6页
Journal of Hebei Medical University
基金
河北省医学科学研究课题计划(20200194)。
