神经内镜与神经导航辅助显微镜下经鼻蝶入路切除垂体瘤的疗效比较
|
摘要
目的比较神经内镜与神经导航辅助显微镜下经鼻蝶入路切除垂体瘤的临床疗效。方法选取湖北医药学院附属襄阳市第一人民医院自2016年1月至2018年7月收治的160例垂体瘤患者,用硬币投掷法随机将患者分为神经内镜组(神经内镜下经鼻蝶入路切除垂体瘤)和神经导航组(神经导航辅助显微镜下经鼻蝶入路切除垂体瘤),每组80例。比较2组患者治疗前后催乳素(PRL)、生长激素(GH)、促肾上腺皮质激素(ACTH)含量,观察2组患者手术指标、临床疗效、并发症的发生情况。结果神经内镜组手术时间短于神经导航组患者,神经内镜组术中出血量少于神经导航组,神经内镜组术后住院时间短于神经导航组。治疗后比较,神经导航组患者PRL、GH、ACTH含量显著高于神经内镜组。神经内镜组患者有效率(92.50%)高于神经导航组(81.25%)。神经内镜组的尿崩症、视力障碍、鼻腔出血发生率均显著低于神经导航组(P<0.05)。结论神经内镜相较于神经导航辅助显微镜下经鼻蝶入路切除垂体瘤,临床疗效更佳,并发症少,患者垂体功能恢复情况更好。
Objective To compare the clinical efficacy of neuroendoscopy and neuronavigation assisted microscopy in the treatment of pituitary tumors by transnasal transsphenoidal approach.Methods One hundred and sixty patients with pituitary adenoma admitted to Xiangyang First People 's Hospital Affiliated to Hubei Medical College from January 2016 to July 2018 were selected. The patients were randomly divided into neural endoscopic group(neural endoscopic nasal adjustment approach resection of pituitary adenoma) and neural navigation group(neural navigation AIDS microscope nasal adjustment approach resection of pituitary adenoma), 80 patients in each group. comparing two groups of patients before and after the treatment of growth hormone, prolactin(PRL), growth hormone(GH) and adrenocorticotropic hormone(ACTH) content difference, comparing two groups of patients with operation indicators, clinical curative effect and complications of statistical difference. Results The operation time in the neuroendoscopic group was shorter than that in the neuronavigation group, the intraoperative blood loss in the neuroendoscopic group was less than that in the neuronavigation group, and the postoperative hospitalization time in the neuroendoscopic group was shorter than that in the neuronavigation group. After treatment, PRL, GH and ACTH contents in patients in the neuronavigation group were significantly higher than those in the neuroendoscopy group. The effective rate of patients in the neuroendoscopic group(92.50%) was higher than that in the neuronavigation group(81.25%). The incidence of diabetes insipidus, visual impairment and nasal bleeding in the neuronavigation group was significantly higher than that in the neuroendoscopy group(P <0.05). Conclusion Compared with neuronavigation-assisted microscopy for the resection of pituitary tumor through nasal transsphenoidal approach, neuroendoscopy has better clinical efficacy, fewer complications and better recovery of pituitary function.
Objective To compare the clinical efficacy of neuroendoscopy and neuronavigation assisted microscopy in the treatment of pituitary tumors by transnasal transsphenoidal approach.Methods One hundred and sixty patients with pituitary adenoma admitted to Xiangyang First People 's Hospital Affiliated to Hubei Medical College from January 2016 to July 2018 were selected. The patients were randomly divided into neural endoscopic group(neural endoscopic nasal adjustment approach resection of pituitary adenoma) and neural navigation group(neural navigation AIDS microscope nasal adjustment approach resection of pituitary adenoma), 80 patients in each group. comparing two groups of patients before and after the treatment of growth hormone, prolactin(PRL), growth hormone(GH) and adrenocorticotropic hormone(ACTH) content difference, comparing two groups of patients with operation indicators, clinical curative effect and complications of statistical difference. Results The operation time in the neuroendoscopic group was shorter than that in the neuronavigation group, the intraoperative blood loss in the neuroendoscopic group was less than that in the neuronavigation group, and the postoperative hospitalization time in the neuroendoscopic group was shorter than that in the neuronavigation group. After treatment, PRL, GH and ACTH contents in patients in the neuronavigation group were significantly higher than those in the neuroendoscopy group. The effective rate of patients in the neuroendoscopic group(92.50%) was higher than that in the neuronavigation group(81.25%). The incidence of diabetes insipidus, visual impairment and nasal bleeding in the neuronavigation group was significantly higher than that in the neuroendoscopy group(P <0.05). Conclusion Compared with neuronavigation-assisted microscopy for the resection of pituitary tumor through nasal transsphenoidal approach, neuroendoscopy has better clinical efficacy, fewer complications and better recovery of pituitary function.
引文
[1]刘陆.全麻下神经内镜引导经鼻蝶入路切除术对垂体瘤的治疗效果观察[J].中国医药指南,2018,16(1):121-122.
[2]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.
[3]霍显浩,王立婷,梁云,等.显微镜及神经内镜下经鼻蝶垂体瘤切除术术后嗅觉功能障碍对比分析[J].临床耳鼻咽喉头颈外科杂志,2017,31(19):1512-1518.
[4]李小绪,张少军.神经导航在经鼻蝶入路垂体瘤显微切除术中的应用研究[J].淮海医药,2018,36(5):527-530.
[5]杜延平,王玉海,梁建广,等.神经内镜及显微镜下垂体瘤切除术的临床比较分析[J].中国医药导刊,2017,19(7):696-697.
[6]陈一,朴浩哲,姚冰,等.经鼻蝶窦神经内镜下垂体瘤切除术并发脑脊液漏的处理策略[J].安徽医药,2017,21(3):522-524.
[7]杨振宇,魏新亭,徐汝飞.神经内镜与显微镜下经鼻蝶垂体瘤切除术的疗效与安全性比较[J].河南医学研究,2017,26(3):402-405.
[8]张坤,张宏义,许斌,等.神经内镜联合神经导航手术治疗侵袭性垂体瘤的疗效观察[J].中国内镜杂志,2013,19(8):814-817.
[9]李明健,肖顺武,谢明祥.神经内镜经鼻蝶垂体瘤手术治疗进展[J].遵义医学院学报,2017,40(2):224-228.
[10]邓跃飞,郑眉光,吴锦铨.可吸收固定系统在开颅骨瓣复位固定手术中的初步应用[J].中国修复重建外科杂志,2012,26(10)55-58.
[11]吴永刚,张诚,黄啸元,等.神经内镜引导下经鼻蝶窦入路切除垂体瘤的临床研究[J].临床与病理杂志,2016,36(7):951-955.
[12]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.
[13]毛建辉,郭洪,郭昊,等.显微镜与神经内镜下单鼻孔经鼻蝶手术治疗功能性垂体瘤的疗效及对激素的影响[J].河北医学,2016,22(6):925-929.
[14]Zhang H,Geng N,Wang Y,et al.Van Wyk and Grumbach syndrome:two case reports and review of the published work[J].JObstet Gynaecol Res,2014,40(2):607-610.
[15]马箭,郭闻师.全麻下神经内镜引导经鼻蝶入路切除术治疗垂体瘤的临床效果[J].陕西医学杂志,2016,45(1):35-36.
[16]钱晓波,刘惠祥,蒋锋.神经导航辅助内镜下经双鼻孔蝶窦入路切除垂体瘤的临床分析[J].中国实用神经疾病杂志,2015,18(18):103-104.
[17]张云强,李斌,周朝阳,等.神经导航及神经内镜下切除垂体腺瘤的疗效观察[J].中华神经外科疾病研究杂志,2018,17(5):458-460.
[18]马逵,王富元,孙维晔.神经导航引导下内镜经蝶入路切除鞍上型巨大垂体瘤[J].河南外科学杂志,2015,21(1):1-3.
[19]贾永军,徐广明.经不同入路行垂体瘤切除术的疗效分析[J].中国临床神经科学,2015,23(2):192-195.
[20]黄朝阳,谢伟,曹志恺.神经导航辅助神经内镜经鼻蝶入路切除垂体瘤的疗效评价[J].广州医药,2018,49(5):67-70.
[2]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.
[3]霍显浩,王立婷,梁云,等.显微镜及神经内镜下经鼻蝶垂体瘤切除术术后嗅觉功能障碍对比分析[J].临床耳鼻咽喉头颈外科杂志,2017,31(19):1512-1518.
[4]李小绪,张少军.神经导航在经鼻蝶入路垂体瘤显微切除术中的应用研究[J].淮海医药,2018,36(5):527-530.
[5]杜延平,王玉海,梁建广,等.神经内镜及显微镜下垂体瘤切除术的临床比较分析[J].中国医药导刊,2017,19(7):696-697.
[6]陈一,朴浩哲,姚冰,等.经鼻蝶窦神经内镜下垂体瘤切除术并发脑脊液漏的处理策略[J].安徽医药,2017,21(3):522-524.
[7]杨振宇,魏新亭,徐汝飞.神经内镜与显微镜下经鼻蝶垂体瘤切除术的疗效与安全性比较[J].河南医学研究,2017,26(3):402-405.
[8]张坤,张宏义,许斌,等.神经内镜联合神经导航手术治疗侵袭性垂体瘤的疗效观察[J].中国内镜杂志,2013,19(8):814-817.
[9]李明健,肖顺武,谢明祥.神经内镜经鼻蝶垂体瘤手术治疗进展[J].遵义医学院学报,2017,40(2):224-228.
[10]邓跃飞,郑眉光,吴锦铨.可吸收固定系统在开颅骨瓣复位固定手术中的初步应用[J].中国修复重建外科杂志,2012,26(10)55-58.
[11]吴永刚,张诚,黄啸元,等.神经内镜引导下经鼻蝶窦入路切除垂体瘤的临床研究[J].临床与病理杂志,2016,36(7):951-955.
[12]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.
[13]毛建辉,郭洪,郭昊,等.显微镜与神经内镜下单鼻孔经鼻蝶手术治疗功能性垂体瘤的疗效及对激素的影响[J].河北医学,2016,22(6):925-929.
[14]Zhang H,Geng N,Wang Y,et al.Van Wyk and Grumbach syndrome:two case reports and review of the published work[J].JObstet Gynaecol Res,2014,40(2):607-610.
[15]马箭,郭闻师.全麻下神经内镜引导经鼻蝶入路切除术治疗垂体瘤的临床效果[J].陕西医学杂志,2016,45(1):35-36.
[16]钱晓波,刘惠祥,蒋锋.神经导航辅助内镜下经双鼻孔蝶窦入路切除垂体瘤的临床分析[J].中国实用神经疾病杂志,2015,18(18):103-104.
[17]张云强,李斌,周朝阳,等.神经导航及神经内镜下切除垂体腺瘤的疗效观察[J].中华神经外科疾病研究杂志,2018,17(5):458-460.
[18]马逵,王富元,孙维晔.神经导航引导下内镜经蝶入路切除鞍上型巨大垂体瘤[J].河南外科学杂志,2015,21(1):1-3.
[19]贾永军,徐广明.经不同入路行垂体瘤切除术的疗效分析[J].中国临床神经科学,2015,23(2):192-195.
[20]黄朝阳,谢伟,曹志恺.神经导航辅助神经内镜经鼻蝶入路切除垂体瘤的疗效评价[J].广州医药,2018,49(5):67-70.