神经内镜与神经导航辅助显微镜下经鼻蝶入路垂体腺瘤切除术的疗效比较
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摘要
目的对比神经内镜与神经导航辅助显微镜下经鼻蝶入路垂体腺瘤切除术的临床疗效,分析两种方法的优缺点。方法回顾性分析空军军医大学唐都医院神经外科2015年2月至2017年2月收治的72例垂体腺瘤患者的临床资料,根据治疗方法的不同将患者分为两组,其中38例行神经内镜下经鼻蝶入路垂体腺瘤切除术(内镜组),34例行神经导航辅助显微镜下经鼻蝶入路垂体腺瘤切除术(导航显微镜组),随访12个月,比较两组患者的疗效和并发症。结果两组患者治疗后的临床症状均显著改善,内镜组及导航显微镜组肿瘤全切率分别为92.11%和85.29%,并发症发生率分别为23.68%和17.65%,差异均无统计学意义(P>0.05);内镜组患者的手术时间为(109.51±25.62) min,长于导航显微镜组的(95.08±21.73) min,住院时间为(13.52±4.73) d,短于导航显微镜组的(16.85±5.95) d,差异均有统计学意义(P<0.05)。结论神经内镜经鼻蝶入路垂体腺瘤切除术与神经导航辅助显微镜下经鼻蝶入路垂体腺瘤切除术临床疗效和安全性相当,均可用于垂体腺瘤的手术治疗,其中前者术后恢复快,后者手术时间短。
Objective To compare the clinical efficacy of endoscope and neuronavigation-assisted microsurgery for pituitary adenoma through transsphenoidal approach, and to analyze the advantages and disadvantages of the two methods. Methods The clinical data of 72 patients with pituitary adenoma, who admitted to Department of Neurosurgery of Tangdu Hospital of Air Force Military Medical University from February 2015 to February 2017, were retrospectively analyzed. According to the different treatment methods, the patients were divided into two groups. Among the72 patients, 38 patients underwent neuroendoscopic transsphenoidal pituitary adenoma resection(endoscopic group), and34 patients underwent neuronavigation-assisted microscopy guided pituitary adenoma resection via transsphenoidal approach(navigation microscope group). The patients were followed up for 12 months. The curative effect and complications were compared between the two groups. Results The clinical symptoms of the two groups were significantly improved after the treatment. The total removal rates of tumors in endoscopic group and navigation microscope group were92.11% and 85.29% respectively(P>0.05), and the incidence of complications were 23.68% and 17.65% respectively(P>0.05). The operative time of the endoscopic group was(109.51 ± 25.62) min, which was significantly longer than(95.08±21.73) min of the navigation microscope group(P<0.05); the hospitalization time in the endoscopic group was(13.52±4.73) days, which was significantly shorter than(16.85±5.95) days in the navigation microscope group(P<0.05).Conclusion Endoscopic transsphenoidal pituitary adenoma resection is as effective and safe as transsphenoidal pituitary adenoma resection under neuronavigation-assisted microscopy. Both of them can be used for pituitary adenoma surgery. The former can recover quickly after operation, while the latter has a short operation time.
Objective To compare the clinical efficacy of endoscope and neuronavigation-assisted microsurgery for pituitary adenoma through transsphenoidal approach, and to analyze the advantages and disadvantages of the two methods. Methods The clinical data of 72 patients with pituitary adenoma, who admitted to Department of Neurosurgery of Tangdu Hospital of Air Force Military Medical University from February 2015 to February 2017, were retrospectively analyzed. According to the different treatment methods, the patients were divided into two groups. Among the72 patients, 38 patients underwent neuroendoscopic transsphenoidal pituitary adenoma resection(endoscopic group), and34 patients underwent neuronavigation-assisted microscopy guided pituitary adenoma resection via transsphenoidal approach(navigation microscope group). The patients were followed up for 12 months. The curative effect and complications were compared between the two groups. Results The clinical symptoms of the two groups were significantly improved after the treatment. The total removal rates of tumors in endoscopic group and navigation microscope group were92.11% and 85.29% respectively(P>0.05), and the incidence of complications were 23.68% and 17.65% respectively(P>0.05). The operative time of the endoscopic group was(109.51 ± 25.62) min, which was significantly longer than(95.08±21.73) min of the navigation microscope group(P<0.05); the hospitalization time in the endoscopic group was(13.52±4.73) days, which was significantly shorter than(16.85±5.95) days in the navigation microscope group(P<0.05).Conclusion Endoscopic transsphenoidal pituitary adenoma resection is as effective and safe as transsphenoidal pituitary adenoma resection under neuronavigation-assisted microscopy. Both of them can be used for pituitary adenoma surgery. The former can recover quickly after operation, while the latter has a short operation time.
引文
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[9]贾艳飞,陈群帮,侯睿哲,等.神经内镜下经鼻蝶治疗垂体肿瘤的研究进展[J].中国肿瘤临床, 2013, 40(18):1137-1140.
[10] Brastianos PK, Batchelor TT. Vascular endothelial growth factor inhibitors in malignant gliomas[J]. Target Oncol, 2010, 5(3):167-174.
[11]刘昉,韩国强,刘窗溪,等.经鼻蝶神经内镜垂体瘤切除术对垂体瘤患者激素水平及视觉功能的影响[J].山东医药, 2018, 58(13):42-44.
[12]毛建辉,郭洪,魏建辉,等.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[J].中国内镜杂志, 2017, 23(12):25-31.
[2]王任直.尤曼斯神经外科学[M].北京:人民卫生出版社, 2009:921.
[3]王海军,毛志钢,何东升.垂体腺瘤经蝶窦手术治疗进展[J].中国微侵袭神经外科杂志, 2013, 18(1):1-4.
[4] Tabaee A, Anand VK, Barron Y, et al. Endoscopic pituitary surgery:a systematic review and meta-analysis[J]. J Neurosurg, 2009, 111(3):545-554.
[5]陈露露,李健,苏贺先.神经内镜与神经导航辅助显微镜下经鼻蝶入路垂体腺瘤切除术的临床疗效对比分析[J].中国微侵袭神经外科杂志, 2016, 21(7):307-309.
[6]周跃飞,冯枫,高大宽,等.神经内镜下双鼻孔入路垂体腺瘤切除术临床分析[J].中华神经外科疾病研究杂志, 2013, 12(3):250-253.
[7]李玉虎.亚低温联合微创穿刺碎吸术治疗高血压脑出血效果分析[J].中国实用神经疾病杂志, 2015, 18(9):14-16.
[8]吴京雷,张严国,罗明,等.神经导航在经鼻蝶垂体腺瘤切除术中的应用体会[J].中国临床神经外科杂志, 2013, 18(8):495-497.
[9]贾艳飞,陈群帮,侯睿哲,等.神经内镜下经鼻蝶治疗垂体肿瘤的研究进展[J].中国肿瘤临床, 2013, 40(18):1137-1140.
[10] Brastianos PK, Batchelor TT. Vascular endothelial growth factor inhibitors in malignant gliomas[J]. Target Oncol, 2010, 5(3):167-174.
[11]刘昉,韩国强,刘窗溪,等.经鼻蝶神经内镜垂体瘤切除术对垂体瘤患者激素水平及视觉功能的影响[J].山东医药, 2018, 58(13):42-44.
[12]毛建辉,郭洪,魏建辉,等.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[J].中国内镜杂志, 2017, 23(12):25-31.