Clinical Study of Neuronavigation-assisted Endoscopic Transnasal Sphenoid Approach for Resection of Pituitary Tumors
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摘要:
目的 探讨全麻下神经导航定位辅助内镜下经鼻蝶入路切除垂体腺瘤的临床应用疗效及前景。 方法 收集阳江市人民医院神经外科2018年9月至2023年4月垂体腺瘤手术患者共68例，分为2组：实验组34例（神经导航定位辅助内镜下经鼻蝶入路切除垂体腺瘤），对照组34例（显微镜经鼻蝶入路切除垂体腺瘤），分析评价2组手术相关指标，并发症指标，手术前后内分泌激素指标。 结果 肿瘤全切几率在术后影像学对比中实验组高于对照组，差异具有统计学意义（P<0.05）。手术时间、出血量、住院时间、手术出血量及术后患者激素指标对比，实验组低于对照组，差异具有统计学意义（P<0.05）。 结论 神经导航辅助内镜下经鼻蝶入路切除垂体腺瘤具有创伤小、安全、高效、住院时间短、全切率高等优点，值得临床推广应用。 Abstract:Objective To explore and analyze the clinical application efficacy and prospect of neuronavigation positioning assisted endoscopic transnasal sphenoid approach for resection of pituitary adenomas under general anesthesia. Methods A total of 68 patients who underwent pituitary adenoma surgery at the Neurosurgery Department of Yangjiang People's Hospital from September 2018 to April 2023 were collected and divided into two groups: an experimental group of 34 patients（neuronavigation-assisted endoscopic transsphenoidal approach for pituitary adenoma resection） and a control group of 34 patients（microscopic transsphenoidal approach for pituitary adenoma resection）. The surgery-related indicators, complication indicators, and preoperative and postoperative endocrine hormone indicators were analyzed and evaluated in both groups. Results The probability of total tumor resection in the experimental group was significantly higher than that in the control group in postoperative imaging comparison, with statistical significance（P<0.05）. The comparison of surgical time, bleeding volume, hospitalization time, surgical bleeding volume, and postoperative patient hormone indicators showed that the experimental group was significantly lower than the control group, and the difference was statistically significant（P<0.05）. Conclusions Neuronavigation positioning assisted endoscopic transnasal sphenoid approach for resection of pituitary adenoma has the advantages of small trauma, safety, high efficiency, short hospital stay, and high total resection rate. This represents a novel and effective strategy for wide clinical application. -
Key words:
- Neural navigation /
- Neuroendoscope /
- Microscope /
- Pituitary adenoma
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图 1 神经内镜下垂体瘤切除术
A：暴露蝶窦前壁；B：打开鞍底及硬膜；C 肿瘤切除。
Figure 1. Neuroendoscopic pituitary tumor resection
图 2 显微镜下垂体瘤切除术
A： 暴露鞍底；B：切开鞍硬膜；C：切除肿瘤。
Figure 2. Microscopic pituitary tumor resection
图 3 神经内镜下手术切除垂体瘤术前后增强影像
A：实验组术前；B：实验组术后。
Figure 3. Enhanced imaging before and after neuroendoscopic surgery for pituitary adenoma resection
图 4 显微镜下手术切除垂体瘤术前后增强影像
A：对照组术前；B：对照组术后。
Figure 4. Enhanced imaging before and after microsurgical resection of pituitary adenoma
表 1 2组间一般资料比较[n（%）/
$ \bar x \pm s $ ]Table 1. Comparison of general information between two groups[n（%）/
$ \bar x \pm s $ ]组别 n 性别 年龄（岁） 病程（a） 肿瘤直径（cm） 男 女 实验组 34 18（52.94） 16（47.05） 48.13 ± 3.11 2.48 ± 1.06 2.81 ± 1.06 对照组 34 15（44.11） 19（55.88） 49.22 ± 1.36 2.32 ± 1.50 2.85 ± 0.67 χ2/t 0.401 0.902 0.212 0.310 P 0.841 0.986 0.647 0.639 
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表 2 2组手术相关指标对比 [
$ \bar x \pm s $ /n（%）]Table 2. Comparison of surgical related indicators between two groups [
$ \bar x \pm s$ /n（%）]组 别 n 手术时间（min） 术中出血量（mL） 住院时间（d） 全切率 实验组 34 94.25 ± 3.23 97.63 ± 1.56 9.34 ± 1.16 30/（88.2） 对照组 34 125.34 ± 2.36 148.33 ± 5.13 13.28 ± 1.56 21/（61.7） t/χ2 9.012 15.206 8.912 10.213 P 0.041* 0.035* 0.047* 0.043* 与对照组相关手术指标比较，*P<0.05。
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表 3 2组相关并发症指标对比[n（%）]
Table 3. Comparison of two groups of related complications indicators[n（%）]
组 别 n 电解质紊乱（n） 垂体功能障碍（n） 一过性尿崩（n） 脑脊液漏（n） 颅内感染（n） 并发症发生几率 实验组 34 6 1 2 2 0 11（32.35） 对照组 34 9 3 4 2 1 19（55.88） χ2 7.823 P 0.035* 与对照组并发症发生几率对比，*P<0.05。
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表 4 2组手术前后内分泌激素指标对比（
$ \bar x \pm s $ ）Table 4. Comparison of endocrine hormone indicators before and after surgery between two groups（
$ \bar x \pm s $ ）组别 n GH（ng/mL） PRL（ng/mL） 治疗前 治疗后 治疗前 治疗后 实验组 34 33.86 ± 1.53 3.15 ± 1.08 21.45 ± 2.35 5.82 ± 1.07 对照组 34 34.25 ± 1.46 7.02 ± 1.03 28.25 ± 2.71 8.92 ± 1.56 t 8.132 9.954 P 0.048 0.039 与对照组术前后生长激素与泌乳素对比，*P<0.05。
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