假包膜外切除技术在生长激素型垂体腺瘤神经内镜下经鼻蝶手术中的应用

Extra-pseudocapsular dissection technique in endoscopic endonasal transsphenoidal surgery for growth hormone-type pituimry adenomas

摘要:

目的 探讨假包膜外切除技术在生长激素（GH）型垂体腺瘤神经内镜下经鼻蝶手术中的应用价值。方法 回顾分析该科于神经内镜下经鼻蝶手术治疗的GH型垂体腺瘤患者118例，根据手术过程，分为假包膜外切除组（55例）和假包膜内切除组（63例），比较两组间术后手术全切率、生化治愈率及并发症发生情况。结果 两组患者肿瘤全切除率差异有统计学意义（ ² = 4.39，P = 0.036）；进一步分析，Knosp分级为2级和3级的患者，两组肿瘤全切除率差异有统计学意义（ ² = 15.03，P = 0.000； ² = 22.13，P = 0.000），大腺瘤患者中，两组肿瘤全切除率差异有统计学意义（ ² = 16.50，P = 0.000）。术后假包膜外切除组生化治愈率87.3%明显高于假包膜内切除组55.6%，差异有统计学意义（ ² = 23.58，P = 0.000）。结论 假包膜外切除技术可以明显提高GH型垂体腺瘤全切除率和术后生化治愈率，具有重要的临床意义。

Abstract:

Objective To evaluate the value of extra-pseudocapsular resection technique in neuroendoscopic transsphenoidal surgery for growth hormone-type pituitary adenomas.Methods 118 patients with growth hormone pituitary adenomas treated by endoscopic transsphenoidal surgery were retrospectively analyzed. According to the operation process, the patients were divided into extra-pseudocapsular resection group (n = 55) and intra-pseudocapsular resection group (n = 63). The total resection rate, biochemical cure rate and complications were compared between the two groups.Results There was a statistical difference in total tumor resection rate between the two groups ( ² = 4.39, P = 0.036). Further analysis showed that Knosp grade was grade 2 and grade 3, and the total tumor resection rate was statistically different between the two groups ( ² = 15.03, P = 0.000; ² = 22.13, P = 0.000), and the total tumor resection rate was statistically different between the large adenoma group ( ² = 16.50, P = 0.000). The biochemical cure rate (87.3%) in the postoperative extra-pseudocapsular resection group was significantly higher than that in the intra-pseudocapsular resection group (55.6%) ( ² = 23.58, P = 0.000).Conclusion The extra-pseudocapsular resection technique can significantly improve the total resection rate and postoperative biochemical cure rate of growth hormone-type pituitary adenoma.