CAJ | 학술논문

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。
목적：비교량충경단비공접두입로미창수체류수술적림상자료병분석기우결점，위림상진료공작제공삼고。방법채취전첨성연구방안，수체선류환자54례자원선택치료방식，분위현미경조31례화신경내경조23례，분별사용경단비공접두입로적현미경수술화신경내경수술치료。관찰비교량조환자적수술시간、술중출혈량、주원시간、유효절제솔、술후적병발증（주요관찰술후일과성뇨붕증화단잠전해질문란）、술후각충격소수평이급환자1년내적수방결과。결과현미경조수술시간（121．3±19．4）min교신경내경조장，단술중출혈량（50．3±3．2）mL교신경내경조적（78．5±7．8）mL소，차이균유통계학의의（t＝0．993、1．032，균P＜0．05）。량조술후주원시간[（8．7±1．1）d여（9．1±2．3）d，t＝2．897，P＞0．05]、유효절제솔（93．5％여91．3％，χ2＝3．191，P＞0．05）차이균무통계학의의，술후병발증（포괄일과성뇨붕증화단잠성전해질문란）차이무통계학의의。내분비격소수평，현미경조화신경내경조술전、술후최유소（PRL）[（387．3±100．8）μg/L여（145．3±27．4）μg/L、（390．2±133．7）μg/L여（148．4±57．2）μg/L]、생장격소（GH）[（63．4±5.7）μg/L여（10．6±2．4）μg/L、（65．6±6．2）μg/L 여（12．4±1．6）μg/L]、촉신상선피질격소（ ACTH）[（202.9±73．7）ng/L여（38．5±4．6）ng/L、（206．8±78．6）ng/L여（35．6±2．5）ng/L]，차이균유통계학의의（t＝1．456、1．301、0．973、1．034、0．774、0，732，균P＜0．05）。결론량충수술방법치료수체선류적료효무명현차별，균구유미창、안전、유효등우점，기중현미경하수술출혈교소，이신경내경수술칙가축단수술시간。
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 =1.456,1.301,0.973,1.034,0.774,0,732,all P <0.05). Conclusion The curative effects of the two surgical treatment of pituitary adenoma have no obvious differences ,they have advantages of minimally invasive , safe and effective, but the microscopic surgery has less bleeding , while neuroendoscopic surgery can shorten the operation time .