神经内镜与显微镜经鼻蝶窦入路切除垂体瘤及对激素水平的影响*

Comparison of neuroendoscopic and microscopic endonasal transsphenoidal pituitary adenoma resection and effects on hormone levels*

摘要:

目的 比较神经内镜下经鼻蝶窦入路垂体瘤切除术与显微镜下垂体瘤切除术的手术效果及对激 素水平和临床症状的影响。方法 回顾性分析2012 年1 月－ 2016 年6 月在该院经手术切除的211 例垂体瘤 患者资料。其中，神经内镜下经鼻蝶窦入路垂体瘤切除术112 例（A 组），显微镜下经鼻蝶窦入路垂体瘤切除 术99 例（B 组），比较两组手术相关指标、出院前激素水平变化及术后24 周症状改善情况。结果 两组患 者肿瘤切除程度不同（Z =2.14，P =0.032），A 组达到全切比例明显高于B 组（79.5% vs 67.7%，P =0.037）；A 组手术时间明显长于B 组[（93.6±26.7）vs（79.8±20.2）min，t =4.26，P =0.000]，A 组术后平均住院天数明 显少于B 组[（7.9±2.5）vs（10.2±4.3）d，t =4.67，P =0.000]，A 组术后并发症发生率明显低于B 组（5.4% vs 14.1%，χ2=4.73，P =0.030）。两组术后激素水平下降程度不同（Z =2.42，P =0.016），A 组出院前激素复常 率明显高于B 组（82.2% vs 66.7%，χ2=6.09，P =0.014），出院前A 组泌乳素腺瘤、促肾上腺皮质激素腺瘤、 生长素腺瘤患者激素下降水平明显高于B 组[（43.2±10.5）vs（33.5±9.1）ng/ml、（26.0±8.8）vs（20.2± 7.0）pmol/L、（11.0±3.9）vs（8.7±3.2）μg/L，t =3.60、t =2.65、t =2.12，均P <0.05]。两组术后24 周临床 症状缓解比例差异无统计学意义（P >0.05）。结论 神经内镜下经鼻蝶窦入路垂体瘤切除术较显微镜手术垂 体瘤切除效率更高，手术并发症更少，更有助于术后激素水平的复常。

Abstract:

Objective To compare the efficacy of neuroendoscopic vs microscopic endonasal transsphenoidal pituitary adenoma resection and effects on hormone levels and clinical symptoms. Methods A retrospective analysis was conducted on 211 cases with pituitary tumor resection patients from January 2012 to June 2016, of which 112 cases with endoscopic endonasal transsphenoidal pituitary tumor resection (group A), 99 cases with microscopic transsphenoidal pituitary tumor resection (group B), and operation related indexes, hormone variations before discharge and symptoms remission 24 weeks after operation were extracted and compared. Results Two groups of patients with different tumor resection extent (Z = 2.14, P = 0.032), group A achieved total resection rate was significantly higher than the group B (79.5% vs 67.7%) (P = 0.037); the operation time of group A was significantly longer than group B [(93.6 ± 26.7) vs (79.8 ± 20.2) min, t = 4.26, P = 0.000], group A with the mean hospitalization stay was significantly less than group B [(7.9 ± 2.5) vs (10.2 ± 4.3) d, t = 4.67, P = 0.000], postoperative complications of group A were significantly lower than those of group B (5.4% vs 14.1%, χ2 = 4.73, P = 0.030). Two groups of postoperative hormone levels decreased in different degree (Z = 2.42, P = 0.016), group A with hormone recovery rate before discharge was significantly higher than group B (82.2% vs 66.7%, χ2 = 6.09, P = 0.014), and decline on prolactinomas, ACTH adenoma, ghrelin hormone were significantly higher than group B [(43.2 ± 10.5) vs (33.5 ± 9.1) ng/ml, (26.0 ± 8.8) vs (20.2 ± 7.0) pmol/L, (11.0 ± 3.9) vs (8.7 ± 3.2) μg/L, t = 3.60, t = 2.65, t = 2.12, all P < 0.05]. There was no significant differences between the two groups in remission of clinical symptoms 24 weeks after operation (P > 0.05). Conclusion Neuroendoscopic endonasal transsphenoidal pituitary adenoma resection is more efficient and less operative complications compared with microscopic surgery, which is more conducive to the recovery of postoperative hormone levels.