内镜与显微镜下经单侧鼻蝶入路手术切除垂体腺瘤的效果和对T淋巴细胞亚群的影响

Endoscopic and microscopic unilateral nasal sphenoid surgery on the resection of pituitary adenoma and the influence of T lymphocyte subsets

摘要:

目的 探讨内镜与显微镜下经单侧鼻蝶入路手术治疗垂体腺瘤的效果。方法 选取2018年10月－2020年10月该院垂体腺瘤患者112例，依据随机数表法分为内镜组与显微镜组，每组各56例。内镜组采取内镜下单侧鼻蝶入路手术，显微镜组采取显微镜下经单侧鼻蝶入路手术。统计两组患者肿瘤切除效果、手术情况、T淋巴细胞亚群指标、应激反应指标［肾素（R）、血管紧张素Ⅱ（ATⅡ）、肾上腺素（E）、去甲肾上腺素（NE）］、生存质量和并发症发生率。结果 内镜组肿瘤全切率（91.07%）高于显微镜组（76.79%）（P < 0.05），手术时间和住院时间较显微镜组短，术中失血量较显微镜组少，住院费用较显微镜组少（P < 0.05），术后1和3 d内镜组CD3⁺、CD4⁺、CD4⁺/CD⁸⁺水平较显微镜组高，血清R、ATⅡ、E和NE水平较显微镜组低（P < 0.05），术后1周内镜组鼻部相关生存质量评分较显微镜组低（P < 0.05），内镜组并发症发生率（5.36%）较显微镜组（17.86%）低（P < 0.05）。结论 与显微镜下经单侧鼻蝶入路手术相比，内镜下手术治疗垂体腺瘤具有肿瘤切除效果好、患者术后恢复快等优势，可减轻应激反应及缓解免疫抑制，值得临床推广。

Abstract:

Objective To investigate the effect of endoscopic and microscope treatment of pituitary adenoma through unilateral nasal sphenoid approach.Methods 112 patients with pituitary adenoma from October 2018 to October 2020 were selected and divided into an endoscopic group and a microscope group, with 56 cases in each group, based on a random number table. In the endoscopy group, a unilateral nasal sphenoid approach under endoscopy was adopted, and the microscope group was performed a unilateral nasal sphenoid approach under a microscope. Statistics of tumor resection effect, operation status, T lymphocyte subgroup indicators, stress response indicators [renin (R), angiotensin Ⅱ (AT Ⅱ), epinephrine (E), norepinephrine (NE)], Quality of life, and complication rate in two groups.Results The tumor total resection rate (91.07%) of the endoscopy group was higher than that of the microscope group (76.79%) (P < 0.05), the length of operation and hospital stay in the endoscopy group were shorter than those of the microscope group, the blood loss during the operation was less than that of the microscope group, and the hospitalization cost was less than that in the microscope group (P < 0.05); CD3⁺, CD4⁺, CD4⁺/CD8⁺ levels in the endoscopic group were higher than those in the microscope group at 1 and 3 days after surgery, and R, AT Ⅱ, E, and NE levels in serum were lower than those in the microscope group (P < 0.05), the nose-related quality of life score 1 week after operation in the endoscopic group was lower than that in the microscope group (P < 0.05), the complication rate of the endoscopic group (5.36%) was lower than that in the microscope group (17.86%) (P < 0.05).Conclusion Compared with unilateral nasal sphenoid surgery under the microscope, endoscopic surgery for patients with pituitary adenoma has the advantages of better tumor resection and faster postoperative recovery, which can reduce stress response and immunosuppression, and is worthy of clinical promotion.