单鼻孔经蝶垂体腺瘤内镜手术和显微镜的对比研究
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摘要
目的：通过解剖和临床研究分析，比较单鼻孔经蝶垂体腺瘤内镜手术与显微镜手术的安全性和有效性。内镜是否优于显微镜，能否成为显微镜之外的另外一种微创技术。方法：分三步。第一步：首先在尸头上进行解剖研究对比，比较单鼻孔经蝶手术内镜和显微镜的正常结构暴露的差异。第二步：利用系统性价和Meta分析的方法对现今世界上所有的文献进行回顾分析，必要时进行合并，比较单鼻孔经蝶垂体腺瘤内镜手术和显微镜手术的有效性和安全性。第三步，对新疆医科大学第一附属医院医院神经外科自2002年1月至2012年6月收治的资料完整的单鼻孔经蝶垂体腺瘤患者进行历史队列研究对比分析。从手术全切率、内分泌缓解率、视力视野恢复、并发症发生、平均住院天数等比较两种手术方式的安全性和有效性。结果：在尸头解剖上内镜的视野广度以及对正常解剖结构的暴露上明显优于显微镜。文献回顾表明内镜手术达到了与显微镜相似的效果。共有本组病人共690例，男性268例，女性412例：最大年龄78岁，最小年龄7岁，平均年龄47.1岁，功能性腺瘤286例，无功能性腺瘤404例。微腺瘤（直径＜lcm）209例，大腺瘤（≥1cm）481例；371例采用显微镜下单鼻孔经蝶手术切除(A组)，319例采用内镜下单鼻孔经蝶手术切除(B组)。两者在肿瘤全切、内分泌缓解、视力视野恢复、手术时间上没有差别，但是在平均住院天数、鼻腔并发症发生上内镜手术优于显微镜。结论：垂体腺瘤的经蝶手术可以借助内镜切除肿瘤也可以借助显微镜下切除肿瘤。两种手术方法在肿瘤平均住院时间方面有显著差异，内镜手术短于显微镜下手术；在肿瘤全切除率、内分泌紊乱缓解、术后视功能恢复、术后并发症、肿瘤复发等方面种术式均没有明显差异。
Objective:To compare efficacy and safety of single-nostril transsphenoidal surgery for pituitary adenomas between endoscopic surgery and microsurgery. Methods:Data of patients who were treated in the first affiliated hospital of XinJiang Medical University from January2002to June2012were analyzed. Results:There are690patients with pituitary adenomas.The average age was47.1(range7to79)years old, There are no difference between two groups about rate of total resection,visual function recovery rate,endocrine reief rate, average operative time(time from the use of epinephrine to shrink the nasal mucosa of nasal packing foam expansion), the average bleeding volume.But the average time of stay in hospital in microsurgery group was higher than that in endoscopic group. The patients after endoscopic surgery feel more comfortable. Conclusion:Transsphenoidal surgery of pituitary adenoma can not only make use of endoscopic bu also under the microscope; Two surgical techniques inpostoperative hospitalization time were significantly different, Endoscopic surgery is superior to operation under the microscope. In bleeding volume, the effective rate of resection, postoperative complications, symptoms; and other aspects of tumorrecurrence in both groups no significant differences; the effective rate of resection of the two operative group Implied endoscopic surgery issuperior to prompt surgical microscope.
Objective:To compare efficacy and safety of single-nostril transsphenoidal surgery for pituitary adenomas between endoscopic surgery and microsurgery. Methods:Data of patients who were treated in the first affiliated hospital of XinJiang Medical University from January2002to June2012were analyzed. Results:There are690patients with pituitary adenomas.The average age was47.1(range7to79)years old, There are no difference between two groups about rate of total resection,visual function recovery rate,endocrine reief rate, average operative time(time from the use of epinephrine to shrink the nasal mucosa of nasal packing foam expansion), the average bleeding volume.But the average time of stay in hospital in microsurgery group was higher than that in endoscopic group. The patients after endoscopic surgery feel more comfortable. Conclusion:Transsphenoidal surgery of pituitary adenoma can not only make use of endoscopic bu also under the microscope; Two surgical techniques inpostoperative hospitalization time were significantly different, Endoscopic surgery is superior to operation under the microscope. In bleeding volume, the effective rate of resection, postoperative complications, symptoms; and other aspects of tumorrecurrence in both groups no significant differences; the effective rate of resection of the two operative group Implied endoscopic surgery issuperior to prompt surgical microscope.
引文
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