CAJ | 학술논문

目的：探讨神经内镜与显微镜经鼻切除功能性垂体瘤术后激素改善的差异性。方法收集并分析2009年3月～2013年11月中国医科大学附属第一医院神经外科58例功能性垂体瘤患者的临床资料。将58例患者按手术方式不同分为两组，显微镜下单鼻孔经鼻蝶手术组34例；神经内镜下经鼻蝶手术组24例。每组患者根据不同激素功能类型分为泌乳素（PRL）腺瘤、生长激素（GH）腺瘤、促肾上腺皮质激素（ACTH）腺瘤。所有患者术后随访皆行垂体激素检测化验及影像学检查。结果显微镜组34例，术后激素恢复正常15例（44．1％），下降＞术前激素水平50％13例（38．2％），无变化6例（17．4％）；内镜组共24例，术后恢复正常17例（70．8％），下降＞术前激素水平50％2例（8．3％），无变化5例（21％）。两组数据比较，差异有统计学意义（χ2检验，P ＜0．05）。结论神经内镜经蝶手术切除功能性垂体腺瘤能显著改善垂体激素水平，在一定程度上优于显微镜手术。
목적：탐토신경내경여현미경경비절제공능성수체류술후격소개선적차이성。방법수집병분석2009년3월～2013년11월중국의과대학부속제일의원신경외과58례공능성수체류환자적림상자료。장58례환자안수술방식불동분위량조，현미경하단비공경비접수술조34례；신경내경하경비접수술조24례。매조환자근거불동격소공능류형분위비유소（PRL）선류、생장격소（GH）선류、촉신상선피질격소（ACTH）선류。소유환자술후수방개행수체격소검측화험급영상학검사。결과현미경조34례，술후격소회복정상15례（44．1％），하강＞술전격소수평50％13례（38．2％），무변화6례（17．4％）；내경조공24례，술후회복정상17례（70．8％），하강＞술전격소수평50％2례（8．3％），무변화5례（21％）。량조수거비교，차이유통계학의의（χ2검험，P ＜0．05）。결론신경내경경접수술절제공능성수체선류능현저개선수체격소수평，재일정정도상우우현미경수술。
Objective To assess the difference of hormone control between transsphenoidal endoscopic surgery and transsphenoidal microsurgery in the treatment of functional pituitary adenoma.Method From March 2009 to November 2013,the clinical data of 58 patients suffered from functional pituitary adenoma were collected and analyzed.58 subjects were divided into two groups according to different surgical approaches,microsurgery treatment group,including 33 patients underwent the single-nostril transsphenoidal microsurgery,and neuroendoscope treatment group,including 25 patients underwent the transsphenoidal neuroendoscopic surgery.The hormone-secreting types included prolactin (PRL),growth hormone (GH),and adrenocorticotro-pichormone (ACTH).Results In microsurgery treatment group,the clinical symptoms improved in 15 cases,and the hormone levels were reduced more than 50% in 13 cases,whereas no obvious hormone changes were observed in 6 cases.In neuroendoscope treatment group,the clinical symptoms improved in 17 cases,and the hormone levels were reduced more than 50% in 2 cases,the other 5 cases showed no obvious hormone change.The statistical analysis demonstrated significant difference between two groups in postoperative hormone improvement (P <0.05).Conclusion Compared with traditional transsphenoidal microsurgery approach,the transsphenoidal neuroendoscopic surgery could markedly improve the postoperative hormone levels,and would be of benefit to functional pituitary adenomas.