Neuroendoscopic transsphenoial surgery versus microscopic transsphenoial surgery for patients with pituitary adenomas

doi:10.3760/cma.j.issn.1007-1245.2024.03.028

Abstract

Abstract:

Objective　To investigate the efficacies of neuroendoscopic transsphenoial surgery versus microscopic transsphenoial surgery for patients with pituitary adenomas and the effects on the levels of serum adrenocorticotropic hormone (ACTH), prolactin (PRL), and growth hormone (GH). Methods　Eighty patients with pituitary adenomas diagnosed and treated in Shanxian Central Hospital from May 2015 to May 2023 were selected for the randomized controlled trial, and were divided into a study group and a control group by the random number table method, with 40 cases in each group. There were 23 males and 17 females in the study group; they were (50.29±5.25) years old. There were 20 males and 20 females in the control group; they were (51.09±5.21) years old. The study group took neuroendoscopic transsphenoial approach resection, while the control group microscopic transsphenoial approach resection. The operation times, intraoperative bleeding volumes, hospitalization times, tumor resection rates, levels of ACTH, PRL, and GH, and incidences of complications were compared between the two groups. Independent sample t and χ² tests were applied. Results　The operation time, hospitalization time, and intraoperative bleeding volume in the study group were less than those in the control group [(81.67±12.03) min vs. (114.35±11.68) min, (7.51±1.18) d vs. (11.07±1.24) d, and (72.59±8.14) ml vs. (85.26±8.31) ml], with statistical differences (t=12.327, 13.154, and 6.889; all P<0.01). The complete resection rate in the study group was higher than that in the control group [87.50% (36/40) vs. 70.00% (28/40); χ²=3.660; P=0.056]. Seven days after the operation, the serum levels of ACTH, PRL, and GH in the study group were lower than those in the control group [(15.37±4.19) pmol/L vs. (20.01±4.38) pmol/L, (1.33±0.48) nmol/L vs. (1.71±0.52) nmol/L, and (0.88±0.31) nmol/L vs. (1.09±0.37) nmol/L], with statistical differences (t=4.841, 3.396, and 2.752; all P<0.05). The incidence of complications in the study group was lower than that in the control group [10.00% (4/40) vs. 27.50% (11/40)], with a statistical difference (χ²=4.021; P=0.045). Conclusion　The neuroendoscopic approach for pituitary adenoma resection is more conducive to promoting the patients' recovery of postoperative hormone levels and reducing the incidence of complications compared to the microscopic approach.

Key words:

Pituitary adenoma, Microscope, Neuroendoscope, Hormone levels

摘要：

目的　研究神经内镜经鼻蝶窦手术与显微镜下经鼻蝶窦手术治疗垂体腺瘤患者的效果及对血清促肾上腺皮质激素（ACTH）、泌乳素（PRL）、生长激素（GH）水平的影响。方法　选取2015年5月至2023年5月单县中心医院收治的80例垂体腺瘤患者进行随机对照试验。采用随机数字表法将其分为研究组和对照组，各40例。研究组男23例，女17例，年龄（50.29±5.25）岁。对照组男20例，女20例，年龄（51.09±5.21）岁。研究组给予神经内镜下经鼻蝶窦入路切除术治疗；对照组给予显微镜下经鼻蝶窦入路切除手术治疗。对比两组患者手术指标（手术用时、术中出血量、住院天数），肿瘤切除率，ACTH、PRL、GH水平，并记录两组并发症发生情况。采用独立样本t检验、χ²检验。结果　研究组手术用时、住院天数均短于对照组［（81.67±12.03）min比（114.35±11.68）min、（7.51±1.18）d比（11.07±1.24）d］，术中出血量少于对照组［（72.59±8.14）ml比（85.26±8.31）ml］，差异均有统计学意义（t=12.327、13.154、6.889，均P<0.01）。研究组完全切除率高于对照组［87.50%（36/40）比70.00%（28/40）；χ²=3.660，P=0.056］。术后7 d，研究组血清ACTH、PRL、GH水平均低于对照组［（15.37±4.19）pmol/L比（20.01±4.38）pmol/L、（1.33±0.48）nmol/L比（1.71±0.52）nmol/L、（0.88±0.31）nmol/L比（1.09±0.37）nmol/L］，差异均有统计学意义（t=4.841、3.396、2.752，均P＜0.05）。研究组并发症发生率为10.00%（4/40），低于对照组的27.50%（11/40），差异有统计学意义（χ²=4.021，P=0.045）。结论　神经内镜下入路切除垂体腺瘤较显微镜下入路更有利于促进患者术后激素水平的恢复，减少并发症发生。

关键词:

垂体腺瘤, 显微镜, 神经内镜, 激素水平

Yang Gongli, Chen Jing.

Neuroendoscopic transsphenoial surgery versus microscopic transsphenoial surgery for patients with pituitary adenomas [J]. International Medicine and Health Guidance News, 2024, 30(3): 489-493.

杨公利陈晶.

神经内镜与显微镜下经鼻蝶窦手术治疗垂体腺瘤患者的效果比较 [J]. 国际医药卫生导报, 2024, 30(3): 489-493.

References

[1] 吕晶,皮丽喆,王清. 呼吸训练对垂体瘤患者术后肺功能及生存质量的影响效果分析[J]. 国际医药卫生导报,2020,26(17):2498-2501. DOI:10.3760/cma.j.issn.1007-1245. 2020.17.001.
[2] 陈宇,谭惠文,刘肖珩,等. 难治性垂体腺瘤的诊治进展[J]. 成都医学院学报,2023,18(2):265-272. DOI:10.3969/j.issn.1674-2257.2023.02.028.
[3] 王学胶,王铁建,张万增. 经鼻蝶入路内镜辅助显微手术切除垂体腺瘤的体会[J]. 中国临床神经外科杂志,2023,28(1):46-47. DOI:10.13798/j.issn.1009-153X.2023.01.014.
[4] 张江红,高国栋,宗建海. 神经内镜与神经导航辅助显微镜下经鼻蝶入路垂体腺瘤切除术的疗效比较[J]. 海南医学,2018,29(24):3446-3448. DOI:10.3969/j.issn.1003-6350. 2018.24.014.
[5] 牛国栋,袁明智,孙青青,等. 经鼻蝶窦入路显微手术与神经内镜手术治疗垂体腺瘤的临床效果比较[J]. 中国临床医生杂志,2021,49(9):1087-1090. DOI:10.3969/j.issn.2095- 8552. 2021.09.024.
[6] 刁宏翠,吴晓雯,林彦琳,等. 垂体腺瘤术后免疫组化分型与术前激素水平相关性研究[J]. 现代肿瘤医学,2020,28(24):4251-4256. DOI:10.3969/j.issn.1672-4992.2020.24.008.
[7] Micko A, Placzek F, Fonollà R,et al. Diagnosis of pituitary adenoma biopsies by ultrahigh resolution optical coherence tomography using neuronal networks[J]. Front Endocrinol (Lausanne), 2021,18(12):730100. DOI: 10.3389/fendo.2021.730100.
[8] 李一君,谷伟军,王岳鹏,等. 4 276例垂体瘤的回顾性临床分析[J]. 国际内分泌代谢杂志,2022,42(1):7-11. DOI:10.3760/cma.j.cn121383-20211110-11036.
[9] 吴波,陈崇毅,杨威,等. 内镜与显微镜下经鼻蝶窦手术治疗垂体瘤的效果及对患者激素水平及视觉功能的影响[J]. 实用癌症杂志,2020,35(8):1284-1287. DOI:10.3969/j.issn.1001-5930.2020.08.017.
[10] 孙娴,王培丽,崔圆元. 黏膜下经内镜垂体瘤切除术与传统经鼻内镜垂体瘤切除术对患者围术期指标、嗅觉功能恢复和并发症的影响[J]. 陕西医学杂志,2023,52(2):192-195. DOI:10.3969/j.issn.1000-7377.2023.02.017.
[11] 王向红,王瑞娟,杨立昌,等. 显微镜术和神经内镜下经鼻蝶窦入路切除术治疗垂体瘤的疗效对比[J]. 中国实用神经疾病杂志,2023,26(7):875-880. DOI:10.12083/SYSJ.230408.
[12] 王少文,代键,谢畅,等. 显微镜与内镜下经鼻-蝶窦垂体瘤切除术对患者嗅觉功能和健康生存质量的影响[J]. 新疆医科大学学报,2023,46(1):104-107. DOI:10.3969/j.issn.1009- 5551.2023.01.017.
[13] Asa SL, Mete O, Perry A, et al. Overview of the 2022 WHO classification of pituitary tumors[J]. Endocr Pathol, 2022, 33(1):6-26. DOI: 10.1007/s12022-022-09703-7.
[14] 梅雪,张菊芬,沈刘艳. 神经内镜与显微镜下经鼻蝶窦入路切除垂体腺瘤的疗效分析[J]. 海军医学杂志,2023,44(1):45-48. DOI:10.3969/j.issn.1009-0754.2023.01.011.
[15] 王岳鹏,李一君,李冰,等. 不同类型垂体腺瘤垂体前叶激素水平与瘤体大小的相关性分析[J]. 中华内科杂志,2023,62(8):979-986. DOI:10.3760/cma.j.cn112138-20221019- 00765.
[16] 胡欣,李兴佳,韩雪,等. 垂体意外瘤的临床诊治:共识与争议[J]. 国际内分泌代谢杂志,2023,43(4):361-364. DOI:10.3760/cma.j.cn121383-20220126-01050.
[17] 王婉,赵兴利,刘晶,等. 雌激素受体拮抗剂对垂体腺瘤GH3细胞增殖、凋亡、催乳素分泌及雌激素受体蛋白表达的影响[J]. 中华神经外科杂志,2012,28(3):285-290. DOI:10.3760/cma.j.issn.1001-2346.2012.03.021.
[18] 邵文钊,吴建中,孙异临. 体外培养人垂体腺瘤细胞分泌生长素、催乳素和促性腺素的研究[J]. 中华神经外科杂志,1985,1(2):72-75, C7. DOI:10.3760/cma.j.issn.1001-2346. 1985.02.105.
[19] 代红伟,王霞,李惺. 功能性垂体腺瘤患者术后早期血清PRL、GH水平及其意义[J]. 实用癌症杂志,2020,35(11):1826-1828,1832. DOI:10.3969/j.issn.1001-5930. 2020.11.022.
[20] 孙青青,任洪波,牛国栋. 内镜和显微手术治疗对垂体腺瘤患者术后血清MMP-9、IGF-1及激素相关指标水平的影响[J]. 国际神经病学神经外科学杂志,2021,48(6):538-541. DOI:10.16636/j.cnki.jinn.1673-2642.2021.06.009.
[21] 郑燎源,张献文,李宗平,等. 垂体腺瘤患者术前血清GH、PRL、ACTH、AGR2表达与术后临床病理特征分析[J]. 国际检验医学杂志,2023,44(7):837-840,847. DOI:10.3969/j.issn.1673-4130.2023.07.013.
[22] 董伟,岳成,张于,等. 神经内镜经鼻蝶入路手术治疗不同级别垂体瘤的效果及降低术后常见并发症的措施分析[J]. 中国综合临床,2020,36(2):166-170. DOI:10.3760/cma.j.issn.1008-6315.2020.02.016.
[23] 罗洪海,黄小山,曾海勇,等. 神经导航引导联合神经内镜经鼻蝶切除垂体腺瘤[J]. 中国实用神经疾病杂志,2023,26(1):36-40. DOI:10.12083/SYSJ.221183.
[24] 谭宝东,崔连旭,赵庆顺,等. 显微镜与神经内镜下经单侧鼻蝶入路手术治疗垂体瘤的效果及并发症[J]. 中国肿瘤临床与康复,2019,26(4):446-449. DOI: 10.13455/j.cnki.cjcor. 2019.04.16.
[25] 王云锋,闫惠颖,杭春华,等. 经鼻蝶入路神经内镜手术联合眶上外侧入路显微手术治疗大型垂体腺瘤[J]. 中国临床神经外科杂志,2022,27(12):961-963. DOI:10.13798/j.issn.1009-153X.2022.12.001.
[26] 邓光策,关北漩,许远鹏,等. 神经内镜下经鼻蝶入路切除垂体腺瘤的临床疗效观察[J]. 现代医学与健康研究(电子版),2023,7(2):57-60. DOI:10.3969/j.issn.2096-3718. 2023.02.017.
[27] 龙潮新,郭铭,官春城,等. 3D-Slicer软件在神经内镜经鼻蝶入路垂体腺瘤手术中的应用[J]. 中国内镜杂志,2022,28(11):77-82. DOI:10.12235/E20210791.
[28] Bopp MHA, Saß B, Pojskić M, et al. Use of neuronavigation and augmented reality in transsphenoidal pituitary adenoma surgery [J]. J Clin Med, 2022, 11(19): 5590. DOI: 10.3390/jcm11195590.
[29] 孙凯颉,李英斌,李清泉,等. 神经内镜下经鼻蝶入路切除无功能性垂体腺瘤临床疗效分析[J]. 临床神经外科杂志,2022,19(2):171-174,181. DOI: 10.3969/j.issn.1672-7770. 2022.02.010.