两种手术方法治疗垂体腺瘤的疗效比较

目的：比较两种经单鼻孔蝶窦入路微创垂体瘤手术的临床资料并分析其优缺点，为临床诊疗工作提供参考。方法采取前瞻性研究方案，垂体腺瘤患者54例自愿选择治疗方式，分为显微镜组31例和神经内镜组23例，分别使用经单鼻孔蝶窦入路的显微镜手术和神经内镜手术治疗。观察比较两组患者的手术时间、术中出血量、住院时间、有效切除率、术后的并发症（主要观察术后一过性尿崩症和短暂电解质紊乱）、术后各种激素水平以及患者1年内的随访结果。结果显微镜组手术时间（121．3±19．4）min较神经内镜组长，但术中出血量（50．3±3．2）mL较神经内镜组的（78．5±7．8）mL少，差异均有统计学意义（t＝0．993、1．032，均P＜0．05）。两组术后住院时间[（8．7±1．1）d与（9．1±2．3）d，t＝2．897，P＞0．05]、有效切除率（93．5％与91．3％，χ2＝3．191，P＞0．05）差异均无统计学意义，术后并发症（包括一过性尿崩症和短暂性电解质紊乱）差异无统计学意义。内分泌激素水平，显微镜组和神经内镜组术前、术后催乳素（PRL）[（387．3±100．8）μg/L与（145．3±27．4）μg/L、（390．2±133．7）μg/L与（148．4±57．2）μg/L]、生长激素（GH）[（63．4±5.7）μg/L与（10．6±2．4）μg/L、（65．6±6．2）μg/L 与（12．4±1．6）μg/L]、促肾上腺皮质激素（ ACTH）[（202.9±73．7）ng/L与（38．5±4．6）ng/L、（206．8±78．6）ng/L与（35．6±2．5）ng/L]，差异均有统计学意义（t＝1．456、1．301、0．973、1．034、0．774、0，732，均P＜0．05）。结论两种手术方法治疗垂体腺瘤的疗效无明显差别，均具有微创、安全、有效等优点，其中显微镜下手术出血较少，而神经内镜手术则可缩短手术时间。

Clinical observation of pituitary adenomas with microscope surgery by single nostril transsphenoidal approach

Objective To compare the two kinds of the single nostril transsphenoidal approach of minimally invasive surgery of pituitary adenoma and analyze the clinical data ,and then provide references for clinical diagnosis and treatment .Methods The prospective study methods were used in the study .A total of 54 cases of pituitary tumor patients were collected , they were randomly divided into microscope group （ 31 cases ） and neural endoscopic group （23 cases）.The operation time,intraoperative blood loss,hospital stay,the resection rate,postoperative complications （ mainly observed transient postoperative insipidus and transient electrolyte disorder ） , the hormone levels , and the comparison the results of patients ,follow-up within 1 year were observed .Results The operation time of microscope group（121.3＋19.4）min was longer than that of the neuroendoscopic group （78.5 ±7.8）ml,but the intraoperative blood loss in the microscope group was less than that of the neuroendoscopic group [（50.3 ±3.2） mL vs （78.5 ± 7.8）mL,t=0.993,1.032,all P〉0.05].The postoperative hospital stay [（8.7 ＋1.1） d vs （9.1 ＋2.3） d,t=2.897,P〉0.05],the resection rate（93.5% vs 91.3%,χ2 =3.191,P〉0.05） had no significant differences be-tween the two groups .The postoperative complications （ including transient insipidus and transient electrolyte disorder ） also had no obvious differences .The analysis of the endocrine hormone levels of different tumors found that there were no significant differences between the microscope group and neuroendoscopic group .The levels of these pre operative and postoperative hormones were as follows：PRL[（387.3 ±100.8）μg/L vs （145.3 ±27.4）μg/L and （390.2 ± 133.7）μg/L vs （148.4 ±57.2）μg/L],GH[（63.4 ±5.7）μg/L vs （10.6 ±2.4）μg/L and （65.6 ±6.2）μg/L vs （12.4 ±1.6）μg/L],ACTH[（202.9 ±73.7）ng/L vs （38.5 ±4.6）ng/L and （206.8 ±78.6）ng/L vs （35.6 ± 2.5）ng/L],they all had significant differences （t =1.45