完全神经内镜下经鼻蝶切除垂体腺瘤学习曲线

目的分析完全神经内镜技术经鼻蝶切除垂体腺瘤手术的学习曲线，为更好开展这类手术提供参考。方法回顾性分析第一作者自初期到成熟期不同阶段连续完成的、完全神经内镜下经鼻蝶切除45例垂体腺瘤病人的临床资料，以每15例作为一个学习曲线阶段．分为初期组、中期组和成熟组。比较各阶段手术病例在手术时间、手术疗效和并发症发生率方面的差异。结果3组病例在年龄、性别和病程上无明显差别（P〉0．05）。术后随访6个月，成熟组比初期组和中期组的手术时间、术中出血量及术后并发症明显减少，而肿瘤全切率明显提高（P〈0．05）；初期组和中期组之间差异无统计学意义（P〉0．05）。三组的术后视力、视野及内分泌障碍均改善，组间无明显差异（P〉0．05）。结论完全神经内镜下经鼻蝶垂体腺瘤切除术学习曲线在30例左右，学习曲线上升期需要提高微创及镜下技巧，保证手术质量，之后进入平台期，技术相对成熟，可以适当扩大手术适应证。

Learning cur.ve of transsphenoidal surgery for pituitary adenoma under neuroendoscope

Objective To analyze the learning curve oftmnssphenoidal surgery under neuroendoscope for pituitary adenoma to provide a reference for better carrying out this kind of operation. Methods Clinical data of 45 patients undergoing neuroendoscopic transsphenoidal surgery for pituitary adenoma were reviewed retrospectively. All the surgeries were completed by the first author at different stages. Every 15 patients were considered as a segment of teaming curve and 45 patients were equally divided into beginning segment group, medium segment group and mature segment group. The differences in operative time, surgical outcome and complication rate were compared between the 3 groups. Results There was no significant difference in age, sex and course of disease between the 3 groups （P 〉 0.05）. During a follow-up period of 6 months, the operative time, intraoperative bleeding and postoperative complication rate in mature segment group decreased obviously compared with beginning segment group and medium segment group,, while the rate of total tumor resection increased significantly （P〈 0.05）, but no significant different between the beginning segment group and medium segment group （P 〉 0.05）. The visual disturbance and endocrine disorder were improved after surgery, and no significant difference found between the 3 group （P 〉 0.05）. Conclusions The learning curve ofneuroendoscopic transsphenoidal surgery for pituitary adenoma is evaluated about 30 procedures. In the rising segment of the learning curve, increasing experience with minimally invasive and gaining endoscopic skill can provide more effective and satisfactory surgery. After entering the plateau, the surgical indications can be gradually expanded.