目的 探讨显微镜与内镜两种手术方式对垂体瘤患者术后嗅觉功能的影响.方法 选取垂体瘤患者进行非随机对照研究.采用中国科学院半导体研究所研制的五味试嗅液对入组患者术前、术后1周和术后1个月的嗅觉功能进行评估.结果 共收治45例符合研究条件的垂体瘤患者,最终31例患者纳入分析,其中内镜下经鼻-蝶窦手术组(Ⅰ组)15例;显微镜下经鼻-蝶窦手术组(Ⅱ组)16例.术前两组患者对每种嗅素的嗅觉识别阈差异无统计学意义(P=0.82).与术前相比,两组患者术后1周均出现嗅觉功能减退甚至消失,平均嗅觉识别阈分别为(4.59 ±0.32)和(4.59±0.31) (P =0.99).两组患者术后1个月平均嗅觉识别阈分别为(3.19±0.40)和(2.76±0.36) (P =0.003),并且显微镜组患者嗅觉异常率明显低于内镜组,分别为6.25％和40.00％,差异有统计学意义(P=0.04).结论 在显微镜下与内镜下经鼻-蝶窦切除垂体瘤,都对患者的主观嗅觉功能产生短期影响,在术后早期嗅觉功能恢复方面,显微镜下操作可能更优于内镜操作.%Objective To investigate the effects of postoperative olfactory function of pituitary adenoma resection by endoscopic and microscopic transsphenoidal approach.Methods The patients were accepted into this non-randomized controlled study.All patients' olfactory functions were evaluated by Five Sniffing Solution before surgery,1 week and 1 month after surgery.Statistical methods include ttest and chi-square test.P ＜ 0.05 means statistically significant difference.Results 45 cases were treated in this study.31 patients were finally included in the analysis.15 cases were underwent endoscopic transsphenoidal approach (group Ⅰ).And 16 cases were underwent microscopic transsphenoidal approach (group Ⅱ).There was no statistically significant difference of preoperative olfactory recognition threshold for each solution (P =0.82).All patients' olfactory function declined or even disappeared 1 week after surgery when compared to pre-operation.The average smell recognition threshold were (4.59 ± 0.32) and (4.59 ±0.31) (P =0.99).The average smell recognition threshold were (3.19 ± 0.40) and (2.76 ± 0.36) 1 month after surgery (P =0.003).The olfactory abnormal rate of group Ⅱ was lower than those in group Ⅰ (6.25 ％ and 40.00％,P =0.04).Conclusions Both endoscopic and microscope transsphenoidal approach for pituitary adenoma resection have a short-term impact on subjective olfactory function.Microscope transsphenoidal approach may be more superior to endoscopic transsphenoidal approach on early postoperative recovery.
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