Ding Zhi-Quan, Zhang Sheng-Fan, Wang Qing-Hua
Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Guangzhou 510282, Guangdong Province, China.
World J Clin Cases. 2019 Jul 6;7(13):1591-1598. doi: 10.12998/wjcc.v7.i13.1591.
Nonfunctional pituitary adenoma is a common type of pituitary adenoma, which can lead to headache, visual field disturbance, and cranial nerve damage due to increased tumor volume. Neuroendoscopic and microscopic transsphenoidal approaches have been widely used in the resection of nonfunctional pituitary adenomas. However, the clinical efficacy in neuroendoscopic and microscopic surgery is still controversial.
To explore the clinical efficacy of neuroendoscopic and microscopic transsphenoidal approach for resection of nonfunctional pituitary adenomas.
We retrospectively analyzed 251 patients with nonfunctional pituitary adenomas; 138 underwent neuroendoscopic surgery transsphenoidal approach, and 113 underwent microscopic surgery transsphenoidal approach between July 2010 and September 2015. All patients were followed up for > 6 mo. Gender, age, course of disease, tumor diameter, tumor location, and percentage of patients with headache, visual impairment, sexual dysfunction, and menstrual disorders were contrasted between the two groups to compare the difference of preoperative data. Cure rate, symptom improvement rate, recurrence rate, the postoperative hospital stay, operating time, intraoperative blood loss, and the incidence of postoperative complications were compared in order to evaluate the advantages and disadvantages of neuroendoscopic and microscopic surgery.
There was no significant difference in cure rate, symptom improvement rate, and recurrence rate between neuroendoscopy group and microscopy group (82.6% 85.8%, > 0.05; 90.6% 93.8%, > 0.05; 5.1% 9.7%, > 0.05). In the neuroendoscopy group, the postoperative hospital stay was 8.4 ± 0.6 d; operating time was 167.2 ± 9.6 min; intraoperative blood loss was 83.4 ± 9.3 mL, and the rates of diabetes insipidus and electrolyte imbalance were 4.3% and 8.0%, respectively. The corresponding results in the microscopic group were 11.2 ± 0.6 d, 199.7 ± 9.3 min, 138.8 ± 13.6 mL, and 32.7% and 20.4%, respectively. There were significant differences in postoperative hospital stay, operating time, intraoperative blood loss, and the rates of diabetes insipidus and electrolyte imbalance between the two groups ( < 0.05).
Neuroendoscopic and microscopic transsphenoidal approaches have similar clinical efficacy for the resection of nonfunctional pituitary adenomas. Neuroendoscopic surgery reduces operating time, intraoperative bleeding, postoperative recovery, and complications.
无功能垂体腺瘤是垂体腺瘤的常见类型，可因肿瘤体积增大导致头痛、视野障碍及脑神经损害。神经内镜和显微镜下经蝶入路已广泛应用于无功能垂体腺瘤的切除。然而，神经内镜手术和显微镜手术的临床疗效仍存在争议。
探讨神经内镜和显微镜下经蝶入路切除无功能垂体腺瘤的临床疗效。
回顾性分析251例无功能垂体腺瘤患者的临床资料，其中138例于2010年7月至2015年9月接受神经内镜下经蝶手术，113例接受显微镜下经蝶手术。所有患者均随访6个月以上。对比两组患者的性别、年龄、病程、肿瘤直径、肿瘤位置以及头痛、视力障碍、性功能障碍和月经紊乱患者的比例，以比较术前数据的差异。比较两组的治愈率、症状改善率、复发率、术后住院时间、手术时间、术中出血量及术后并发症发生率，以评估神经内镜手术和显微镜手术的优缺点。
神经内镜组与显微镜组在治愈率、症状改善率及复发率方面差异无统计学意义（82.6%对85.8%，P>0.05；90.6%对93.8%，P>0.05；5.1%对9.7%，P>0.05）。神经内镜组术后住院时间为8.4±0.6天，手术时间为167.2±9.6分钟，术中出血量为83.4±9.3毫升，尿崩症和电解质紊乱发生率分别为4.3%和8.0%。显微镜组相应结果分别为11.2±0.6天、199.7±9.3分钟、138.8±13.6毫升、32.7%和20.4%。两组在术后住院时间、手术时间、术中出血量及尿崩症和电解质紊乱发生率方面差异有统计学意义（P<0.05）。
神经内镜和显微镜下经蝶入路切除无功能垂体腺瘤的临床疗效相似。神经内镜手术可缩短手术时间、减少术中出血、促进术后恢复并降低并发症发生率。
