神经内镜与显微镜下单鼻孔切除垂体巨大腺瘤的疗效对比

目的 比较神经内镜与显微镜下经单鼻孔-经蝶窦入路切除垂体巨大腺瘤的疗效及术后生存质量。方法 选取2009年1月至2013年12月,27例经显微镜下单鼻孔-经蝶入路切除垂体巨大腺瘤患者(显微镜组)与20例经内镜下单鼻孔-经蝶入路切除垂体巨大腺瘤患者(内镜组)的术中术后情况进行比较。术后6个月采用健康调查简表(SF-36)、综合性医院焦虑抑郁量表(HADS)对两组患者进行比较。结果 内镜组18例肿瘤全切除,2例大部分切除,全切率为90%,显微镜组22例肿瘤全切除,5例大部切除,全切除率为81.5%。内镜组手术时间与显微镜组差异无统计学意义(t=-0.23,P=0.823);内镜组住院时间短于显微镜组(t=-11.693,P=0.001)。显微镜组术后并发尿崩症10例,鼻中隔穿孔8例,脑脊液漏1例;内镜组出现术后一过性尿崩8例,脑脊液漏1例。两组患者术后并发症发生率差异无统计学意义(P>0.005)。F-36调查结果提示内镜组总体健康指数高于显微镜组(t=3.364,P=0.002);HADS提示两组焦虑指数差异无统计学意义(t=0.462,P=0.648),抑郁指数差异亦无统计学意义(t=0.154,P=0.879)。47例均随访3~12个月,平均6.7月,无肿瘤复发。结论 神经内镜和显微镜下单鼻孔经蝶入路切除垂体巨大腺瘤疗效满意,但内镜下治疗可使患者获得更满意的生存质量。

Comparison of neuroendoscopy and microscopy for transnasal resection of giant pituitary adenomas

Objective To compare the efficacy and the quality of life(QOL) of transnasal endoscopic or microscopic resection of giant pituitary adenomas(GPA). Methods From January 2009 to December 2013, 27 cases of GPA which could be resected by transsphenoidal approach were selected to undergo microscopic surgery via transsphenoidal single-nostril resection (microscope group). Another 20 cases of GPA who showed indications for transsphenoidal surgery received endoscopic resection through transsphenoidal single-nostril approach(endoscope group). The peri-operative and post-operative conditions of patients were compared. Moreover, SF-36 and HADS were applied in the evaluation 6 months after surgery. Results In the endoscope group, the 18 in 20 tumors were totally removed with a resection rate of 90%; in the microscope group, 22 tumors were totally removed and 5 tumors were subtotally removed with a rate of complete resection of 81.5%. The operation time of the two groups showed no significant difference, but there was shorter hospital stay(t=-11.693,P=0.001) in the endoscope group. In the microscope group, postoperative diabetes insipidus was developed in 10 cases, nasal septum defect in 8 cases, and cerebrospinal fluid leakage in 1 case. In the endoscope group, postoperative diabetes insipidus occurred in 8 patients, and cerebrospinal fluid leakage occurred in 1 case. SF-36 indicated that the general health index of the endoscope group was significantly higher than that of the microscope group(t=3.364,P=0.002). While HADS suggested that no significant difference existed in the anxiety index and depression index between the two groups(t=0.462, P=0.648; and t=0.154, P=0.879, respectively). Follow-up was available in both groups(47 cases in total)for 3 to 12 months with a mean of 6.7 months. No tumor recurrence was found in the patients. Conclusion Both endoscopic and microscopic resection of GPA through transsphenoidal approach are effective and safe, while endoscopic transphenoid surgery achieves higher QOL than microscopy for patients with GPA.