神经内镜下与显微镜下经鼻蝶窦入路手术对垂体瘤患者嗅觉、视觉功能和激素水平的影响

谢瑞禄 刘德华

【摘要】 目的：探討神经内镜下与显微镜下经鼻蝶窦入路手术治疗垂体瘤患者的临床效果。方法：选择2016年1月-2020年3月本院接诊的84例垂体瘤患者，按随机数字表法分为干预组和对照组，各42例。两组均行经鼻蝶窦入路手术治疗，干预组手术在神经内镜下操作，对照组在显微镜下操作。比较两组围术期指标、嗅觉、视觉功能和激素水平及并发症发生情况。结果：干预组手术时间、术后住院时间均短于对照组，术中出血量低于对照组，差异均有统计学意义（P<0.05）。术后3周，干预组VFI水平高于对照组，嗅觉功能评分、PSD及MD水平均低于对照组，差异均有统计学意义（P<0.05）。术后3周，干预组PRL水平低于对照组，差异有统计学意义（P<0.05）;术后3周，两组ACTH、GH水平比较，差异均无统计学意义（P>0.05）。干预组术后并发症发生率低于对照组，差异有统计学意义（P<0.05）。结论：与显微镜下手术相比，神经内镜下经鼻蝶窦入路手术具有出血少、创伤小、并发症少、恢复快等优点，能够有效改善患者嗅觉、视觉功能和激素水平。

【关键词】 垂体瘤 经鼻蝶窦入路手术 神经内镜 视觉功能 显微镜 嗅觉功能

Effects of Neuroendoscopic and Microscopical Transsphenoidal Sinus Approach on Olfactory and Visual Functions and Hormone Levels in Patients with Pituitary Tumor/XIE Ruilu， LIU Dehua. //Medical Innovation of China， 2021， 18（27）： 0-032

[Abstract] Objective： To investigate the clinical effect of neuroendoscopic and microscopical transsphenoidal sinus approach in the treatment of pituitary tumor. Method： A total of 84 patients with pituitary tumor treated in our hospital from January 2016 to March 2020 were selected. According to random number table method， they were divided into intervention group and control group， 42 cases in each group. Transsphenoidal sinus approach was performed in both groups， the intervention group was operated under neuroendoscope， the control group was operated under microscope. Perioperative indicators， olfactory and visual functions， hormone levels and complications were compared between the two groups. Result： The operation time and postoperative hospitalization time of the intervention group were shorter than those of the control group， the intraoperative blood loss was lower than that of the control group， the differences were statistically significant （P<0.05）. 3 weeks after surgery， the VFI level of the intervention group was higher than that of the control group， the olfactory function score， PSD and MD levels were lower than those of the control group， the differences were statistically significant （P<0.05）. 3 weeks after surgery， the PRL level in the intervention group was lower than that in the control group， the difference was statistically significant （P<0.05）. 3 weeks after surgery， comparison of ACTH and GH levels between the two groups， there were no significant differences （P>0.05）. The incidence of postoperative complications in the intervention group was lower than that in the control group， the difference was statistically significant （P<0.05）. Conclusion： Compared with microsurgery， endoscopic transnasal transsphenoidal approach has the advantages of less bleeding， less trauma， less complications and rapid recovery. It can effectively improve patients’ olfactory， visual function and hormone level.

[Key words] Pituitary tumor Transsphenoidal sinus approach Neuroendoscopy Visual function Microscope Olfactory function

First-author’s address： The First Affiliated Hospital of Gannan Medical College， Ganzhou 341000， China

doi：10.3969/j.issn.1674-4985.2021.27.008

垂体瘤发生率居颅内肿瘤的第三位，其发生与垂体前叶功能减退、激素分泌异常等有关，患者多伴有视野损害、视力减退等症状[1-2]。因垂体具有特殊的生理功能和解剖结构，手术切除是临床治疗垂体瘤的首选，其中经鼻蝶窦入路手术较为常见。神经内镜下与显微镜下经鼻蝶窦入路手术能够更准确地定位、观察肿瘤，缩短手术时间，促进患者病情恢复，逐渐取代传统开颅术式，被广泛应用于临床[3-5]。……