经眉弓锁孔入路与单鼻孔蝶窦入路显微手术治疗垂体腺瘤的比较

摘要

Objective To compare the clinical effects of microneurosurgery by supraorbital key-hole or endonasal transsphenoidal approaches in the treatment of pituitary adenoma and investigate their complications. Methods We retrospectively analyzed the data of 87 patients with pituitary adenoma of which the anteroposterior diameter was less than 3 cm. These patients, admitted to our hospital from May, 2006 to June, 2008, were operated in an endoscope-assisted microsurgical manner via a supraorbital key-hole approach (n=42) or an endonasal transsphenoidal approach (n=45). The efficacy of these two approaches was compared and their complications were observed. Results The excision rate of the pituitary adenoma developing on or around the sella turcica operated through the supraorbital key-hole approach was significantly higher than that through the endonasal transsphenoidal approach(P< 0.05); while that of microadenoma or adenoma developing towards the sphenoid sinus operated through the supraorbital keyhole approach was statistically lower than that through the endonasal transsphenoidal approach (P<0.05). No obvious differences on the improvement of endocrine secretion, visual acuity and field was noted in these two approaches (P>0.05). The incidence rate of epistaxis and unilateral dysosphresia in the supraorbital key-hole approach was significantly lower as compared with that in the endonasal transsphenoidal approach (P<0.05). Conclusion Rarely having such complications as dysosphresia, epistaxis and sphenoiditis, neuroendoscopic surgery through supraorbital key-hole approach is the best way of treating the pituitary adenoma developing on or around the sella turcica and worth to promote in clinic.%目的 比较经眉弓锁孔入路和单鼻孔蝶窦入路显微手术治疗垂体腺瘤的临床效果和并发症. 方法 山东省聊城市脑科医院自2006年5月至2008年6月应用内镜辅助显微手术治疗直径≤3 cm的垂体腺瘤87例,其中经眉弓锁孔入路42例,经单鼻孔蝶窦入路45例,比较两种手术入路方式的临床效果和并发症的发生率. 结果 眉弓锁孔入路组向鞍上、鞍旁生长的肿瘤全切率(93.3%)高于单鼻孔蝶窦入路组(53.8%),微腺瘤和向蝶窦方向生长的肿瘤全切率低于单鼻孔蝶窦入路组,差异均有统计学意义(P<0.05);两组患者垂体内分泌功能及视力、视野改善率差异无统计学意义(P>0.05);眉弓锁孔入路组患者术后鼻衄和一侧嗅觉减退发生率(0,0)明显低于单鼻孔蝶窦入路组(11%,20%),差异有统计学意义(P<0.05).结论 眉弓锁孔入路手术无嗅觉减退、鼻衄、蝶窦炎等并发症的发生,适于向鞍上、鞍旁生长的垂体腺瘤,具有较大的临床推广价值.