神经内镜下经蝶手术治疗巨大侵袭性垂体腺瘤的临床效果观察
|
摘要
目的:观察在巨大侵袭性垂体腺瘤的治疗中采取神经内镜下经蝶手术治疗的临床效果。方法:将笔者所在医院于2015年1月-2017年12月收治的以巨大侵袭性垂体腺瘤为诊断的患者112例,按随机数字表法分成对照组(56例)与试验组(56例)。试验组采取神经内镜下经蝶手术治疗,对照组采取显微镜下经蝶手术治疗,并对两组患者进行为期1年的随访。对比两组手术时长、术中出血量、住院总时长、肿瘤全切率、术后并发症发生率、复发率。结果:试验组的术中出血量、住院总时长均明显优于对照组,差异均有统计学意义(P<0.01)。试验组的肿瘤全切率为98.21%,术后并发症发生率为7.15%,复发率为1.79%,均明显优于对照组的87.50%、19.64%、12.50%,差异均有统计学意义(P<0.05)。结论:在巨大侵袭性垂体腺瘤的临床治疗中,采取神经内镜下经蝶手术治疗,术中创伤小,肿瘤全切率高,术后并发症与复发率更低。
Objective:To observe the clinical effect of neuroendoscopic transsphenoidal surgery in the treatment of giant invasive pituitary adenomas.Method:A total of 112 patients with giant invasive pituitary adenomas were treated in author's hospital from January 2015 to December 2017.They were randomly divided into the control group(56 cases) and the experimental group(56 cases).The experimental group was treated with neuroendoscopic transsphenoidal surgery,while the control group was treated with transsphenoidal surgery under microscope.The patients in the two groups were followed up for one year.The two groups were compared in terms of operation time,intraoperative blood loss,total length of hospitalization,total tumor resection rate,incidence of postoperative complications and recurrence rate.Result:The intraoperative blood loss and the total length of hospitalization in the experimental group were significantly better than those of the control group,and the differences were statistically significant(P<0.01).The total tumor resection rate was 98.21%,the incidence of postoperative complications was 7.15%,the recurrence rate was 1.79% in the experimental group,were significantly better than the control group of 87.50%,19.64%,12.50%,and the differences were statistically significant(P<0.05).Conclusion:In the clinical treatment of giant invasive pituitary adenomas,neuroendoscopic transsphenoidal surgery has the advantages of less trauma,higher total tumor resection rate and lower incidence of postoperative complications and recurrence rate.
Objective:To observe the clinical effect of neuroendoscopic transsphenoidal surgery in the treatment of giant invasive pituitary adenomas.Method:A total of 112 patients with giant invasive pituitary adenomas were treated in author's hospital from January 2015 to December 2017.They were randomly divided into the control group(56 cases) and the experimental group(56 cases).The experimental group was treated with neuroendoscopic transsphenoidal surgery,while the control group was treated with transsphenoidal surgery under microscope.The patients in the two groups were followed up for one year.The two groups were compared in terms of operation time,intraoperative blood loss,total length of hospitalization,total tumor resection rate,incidence of postoperative complications and recurrence rate.Result:The intraoperative blood loss and the total length of hospitalization in the experimental group were significantly better than those of the control group,and the differences were statistically significant(P<0.01).The total tumor resection rate was 98.21%,the incidence of postoperative complications was 7.15%,the recurrence rate was 1.79% in the experimental group,were significantly better than the control group of 87.50%,19.64%,12.50%,and the differences were statistically significant(P<0.05).Conclusion:In the clinical treatment of giant invasive pituitary adenomas,neuroendoscopic transsphenoidal surgery has the advantages of less trauma,higher total tumor resection rate and lower incidence of postoperative complications and recurrence rate.
引文
[1] Gupta R K,Saran R K,Srivastava A K,et al.T cell lymphoblastic lymphoma/leukemia within an adrenocorticotropic hormone and thyroid stimulating hormone positive pituitary adenoma:A cytohistological correlationemphasizingimportanceofintra-operativesquash smear[J].Neuropathology:Official Journal of the Japanese Society of Neuropathology,2017,37(4):358-364.
[2]郭英,李文胜,蔡梅钦,等.全神经内镜下经鼻蝶入路手术治疗垂体腺瘤72例临床分析[J].中华显微外科杂志,2012,35(5):364-366.
[3]马俊伟,王之敏,蒋栋毅,等.神经内镜下经鼻蝶窦入路垂体腺瘤切除术联合鞍底重建的效果[J].实用临床医学,2017,18(4):51-52.
[4]韩鹏,李旭琴,于军,等.多模态影像导航融合技术在神经内镜经蝶垂体腺瘤切除术中的应用体会[J].中国微侵袭神经外科杂志,2017,22(7):322-325.
[5]董韬,魏学忠,冯思哲,等.神经内镜与显微镜经单鼻孔蝶窦入路垂体腺瘤切除术的临床效果对比分析[J].中国临床神经外科杂志,2012,17(11):682-684.
[6]张科,王斌,王先祥,等.神经内镜辅以高速磨钻单鼻孔经蝶入路垂体腺瘤切除术[J].中华神经外科疾病研究杂志,2015,14(6):554-556.
[7] Bengtsson D,Joost P,Aravidis C,et al.Corticotroph Pituitary Carcinoma in a patient with Lynch syndrome(LS)and pituitary tumors in a nationwide LS cohort[J].Journal of Clinical Endocrinology&Metabolism,2017,102(11):3928-3932.
[8]叶经纬,张立,钱晓波,等.神经导航辅助下经鼻蝶入路神经内镜切除垂体腺瘤22例临床分析[J].中国内镜杂志,2016,22(11):92-94.
[9]李舜,唐晓平,张柳,等.神经内镜与显微镜在单鼻孔蝶窦入路切除垂体瘤患者中的疗效及并发症观察[J].中国实用神经疾病杂志,2017,20(7):15-18.
[10]张艳阳,陈晓雷,孟祥辉,等.3D-SPACE序列在脑脊液鼻漏诊断及导航辅助鼻内镜修补术的应用[J].中国医学影像学杂志,2016,24(2):96-99.
[11]何润之,王振海,孔世奇,等.神经内镜辅助经蝶显微手术对分泌生长激素的脑垂体腺瘤患者生长激素及预后的影响[J].临床误诊误治,2017,30(5):101-105.
[12]陈红春,卞晓星,蒋文庆,等.神经内镜下经鼻蝶入路切除侵袭性垂体腺瘤10例临床分析[J].江苏医药,2016,42(18):2064-2065.
[2]郭英,李文胜,蔡梅钦,等.全神经内镜下经鼻蝶入路手术治疗垂体腺瘤72例临床分析[J].中华显微外科杂志,2012,35(5):364-366.
[3]马俊伟,王之敏,蒋栋毅,等.神经内镜下经鼻蝶窦入路垂体腺瘤切除术联合鞍底重建的效果[J].实用临床医学,2017,18(4):51-52.
[4]韩鹏,李旭琴,于军,等.多模态影像导航融合技术在神经内镜经蝶垂体腺瘤切除术中的应用体会[J].中国微侵袭神经外科杂志,2017,22(7):322-325.
[5]董韬,魏学忠,冯思哲,等.神经内镜与显微镜经单鼻孔蝶窦入路垂体腺瘤切除术的临床效果对比分析[J].中国临床神经外科杂志,2012,17(11):682-684.
[6]张科,王斌,王先祥,等.神经内镜辅以高速磨钻单鼻孔经蝶入路垂体腺瘤切除术[J].中华神经外科疾病研究杂志,2015,14(6):554-556.
[7] Bengtsson D,Joost P,Aravidis C,et al.Corticotroph Pituitary Carcinoma in a patient with Lynch syndrome(LS)and pituitary tumors in a nationwide LS cohort[J].Journal of Clinical Endocrinology&Metabolism,2017,102(11):3928-3932.
[8]叶经纬,张立,钱晓波,等.神经导航辅助下经鼻蝶入路神经内镜切除垂体腺瘤22例临床分析[J].中国内镜杂志,2016,22(11):92-94.
[9]李舜,唐晓平,张柳,等.神经内镜与显微镜在单鼻孔蝶窦入路切除垂体瘤患者中的疗效及并发症观察[J].中国实用神经疾病杂志,2017,20(7):15-18.
[10]张艳阳,陈晓雷,孟祥辉,等.3D-SPACE序列在脑脊液鼻漏诊断及导航辅助鼻内镜修补术的应用[J].中国医学影像学杂志,2016,24(2):96-99.
[11]何润之,王振海,孔世奇,等.神经内镜辅助经蝶显微手术对分泌生长激素的脑垂体腺瘤患者生长激素及预后的影响[J].临床误诊误治,2017,30(5):101-105.
[12]陈红春,卞晓星,蒋文庆,等.神经内镜下经鼻蝶入路切除侵袭性垂体腺瘤10例临床分析[J].江苏医药,2016,42(18):2064-2065.