神经内镜经双侧鼻中隔黏膜下入路治疗垂体腺瘤的疗效分析

【摘要】目的探讨神经内镜经双侧鼻中隔黏膜下入路在垂体腺瘤外科治疗的手术疗效。方法回顾性分析50例垂体瘤患者的临床资料，根据手术方式分为黏膜入路组（n=26）与经典入路组（n=24），并在围手术期观察指标（手术时间、术中出血量、术中脑脊液漏、术后住院时间）、肿瘤切除率、激素生化缓解率及术后并发症率上进行比较分析。结果黏膜入路组与经典入路组，在手术时间/术中脑脊液漏/手术出血量指标上无明显差异，P值（0.089 7/0.385/1.000）均大于0.05；肿瘤切除效果上，两组全切率均为88%，两者无明显性差异（χ2=0.110，P=0.917）。黏膜入路组激素生化缓解率为83%，经典入路组为63%，两组之间无统计学差异（χ2=1.847，P=0.174>0.05）。术后并发症上，两组在术后短暂性尿崩、颅内感染、垂体功能下降上无统计学差异，P分别为0.174/1.000/0.480/0.623，均大于0.05；术后住院时间及鼻部并发症的P值分别为0.001/0.022小于0.05，存在显著性差异。结论与经典的内镜下双侧经鼻蝶入路垂体瘤切除术相比，神经内镜经双侧鼻中隔黏膜下入路在垂体瘤切除上能够更好地保护鼻腔解剖结构与功能，减少术后住院时间与鼻部并发症发生率，同时也是一个安全有效的手术方式。

Abstract： Objective To explore the efficacy of neuroendoscopic transseptal submucosal approach in the surgical treatment of pituitary adenomas. Methods The clinical data of 50 patients with pituitary adenoma were analyzed retrospectively. According to the operation method, they were divided into mucosal approach group(n=26) and classical approach group(n=24). The perioperative observation indexes(operation time, intraoperative bleeding, intraoperative cerebrospinal fluid leakage, postoperative hospital stay), tumor resection rate, hormone biochemical remission rate and postoperative complication rate were compared and analyzed. Results There was no significant difference in operation time/intraoperative cerebrospinal fluid leakage/operation bleeding between mucosal approach group and classical approach group, P values(0.089 7/0.385/1.000) were greater than 0.05. In the effect of tumor resection, the total resection rate of the two groups was 88%, and there was no significant difference between the two groups（χ2= 0.110，P=0.917）. The hormone biochemical remission rate was 83% in the mucosal approach group and 63% in the classical approach group. There was no significant difference between the two groups（χ2= 1.847，P=0.174>0.05）. In terms of postoperative complications, there was no significant difference in postoperative transient diabetes insipidus, intracranial infection and decline of pituitary function between the two groups(P>0.05, 0.174/1.000/0.480/0.623, respectively). The P values of postoperative hospital stay and nasal complications were 0.001/0.022 and less than 0.05, respectively. Conclusions Compared with the classic neuroendoscopic bilateral transsphenoidal approach for pituitary adenoma, the neuroendoscopic bilateral transseptal submucosal approach can better protect the nasal anatomy and function in pituitary tumor resection, and reduce postoperative hospital stay and nasal complication. It is also a safe and effective surgical method.