PDF(Pubmed)
Abstract：
UNASSIGNED: Transsphenoidal surgery, including endoscopic and microscopic resection, is the first choice of treatment for pituitary tumors. With the widespread application of neuroendoscopy in recent decades, there has been a trend to replace microscopes. In clinical practice, we have found that in transsphenoidal surgery for non-invasive microadenomas and macroadenomas, microscopy can achieve a higher total resection rate, shorter operation time, lower incidence of postoperative complications, and faster recovery of olfaction. This study aimed to explore the selection of endoscopes and microscopes for non-aggressive transsphenoidal surgery for pituitary adenomas and the factors affecting olfactory recovery.
UNASSIGNED: From August 2019 to October 2022, 93 patients with non-aggressive microadenomas and macroadenomas via the transsphenoidal approach were selected from the First Affiliated Hospital of Harbin Medical University and treated with rich experience in pituitary tumor subspecialty microscopy and endoscopic surgery. Different surgical methods were used to divide the patients into microscopic (n = 35) and endoscopic (n = 58) groups. The total tumor removal rate, intraoperative blood loss, operation time and cost, postoperative hospital stay, recovery of visual function, postoperative changes in hormone levels, complication rate, and recovery from complications 3 months after the operation were compared between the two groups.
UNASSIGNED: There were no significant differences in the tumor removal rate, postoperative visual acuity, and visual field recovery between the two groups (p > 0.05). There was a significant difference in the recovery rate of olfactory function between the two groups 3 months after the operation (p < 0.05), and there was no significant difference in the incidence of other complications (p > 0.05); Compared with the two groups, the microscope group had shorter operation time, longer postoperative hospital stay, less average operation cost and less blood loss, and the difference was statistically significant (p < 0.05). The position of the nasal septum mucosal flap incision was a risk factor for hyposmia 3 months after the operation.
UNASSIGNED: Microsurgery and endoscopic surgery are suitable surgical treatments for nonaggressive microadenomas and macroadenomas. The total tumor removal and postoperative hormone remission rates of the two surgical methods were approximately the same. However, the microsurgery group had a shorter operation time, less intraoperative blood loss, faster olfactory function recovery, and a lower average operation cost. The position of the nasal septal mucosal flap incision was a risk factor for hyposmia at 3 months postoperatively. Hyposmia is less likely to occur when the superior edge of the nasal septal mucosal flap incision is not higher than the lower edge of the ipsilateral superior turbinate.
UNASSIGNED: From August 2019 to October 2022, 93 patients with non-aggressive microadenomas and macroadenomas via the transsphenoidal approach were selected from the First Affiliated Hospital of Harbin Medical University and treated with rich experience in pituitary tumor subspecialty microscopy and endoscopic surgery. Different surgical methods were used to divide the patients into microscopic (n = 35) and endoscopic (n = 58) groups. The total tumor removal rate, intraoperative blood loss, operation time and cost, postoperative hospital stay, recovery of visual function, postoperative changes in hormone levels, complication rate, and recovery from complications 3 months after the operation were compared between the two groups.
UNASSIGNED: There were no significant differences in the tumor removal rate, postoperative visual acuity, and visual field recovery between the two groups (p > 0.05). There was a significant difference in the recovery rate of olfactory function between the two groups 3 months after the operation (p < 0.05), and there was no significant difference in the incidence of other complications (p > 0.05); Compared with the two groups, the microscope group had shorter operation time, longer postoperative hospital stay, less average operation cost and less blood loss, and the difference was statistically significant (p < 0.05). The position of the nasal septum mucosal flap incision was a risk factor for hyposmia 3 months after the operation.
UNASSIGNED: Microsurgery and endoscopic surgery are suitable surgical treatments for nonaggressive microadenomas and macroadenomas. The total tumor removal and postoperative hormone remission rates of the two surgical methods were approximately the same. However, the microsurgery group had a shorter operation time, less intraoperative blood loss, faster olfactory function recovery, and a lower average operation cost. The position of the nasal septal mucosal flap incision was a risk factor for hyposmia at 3 months postoperatively. Hyposmia is less likely to occur when the superior edge of the nasal septal mucosal flap incision is not higher than the lower edge of the ipsilateral superior turbinate.
摘要：
■经蝶窦手术,包括内窥镜和显微镜切除，是治疗垂体瘤的首选。随着近几十年来神经内镜的广泛应用,有取代显微镜的趋势。在临床实践中,我们发现，在非侵入性微腺瘤和大腺瘤的经蝶窦手术中，显微镜可以实现更高的总切除率，更短的操作时间，术后并发症发生率较低，和更快的嗅觉恢复。本研究旨在探讨非侵袭性垂体腺瘤经蝶入路手术的内镜和显微镜选择及影响嗅觉恢复的因素。
■自2019年8月至2022年10月，选择哈尔滨医科大学附属第一医院经鼻蝶入路非侵袭性微腺瘤和大腺瘤患者93例，在垂体瘤亚专科显微镜和内镜手术方面均有丰富经验。采用不同的手术方法将患者分为显微镜组（n=35）和内镜组（n=58）。肿瘤总切除率，术中失血,运营时间和成本，术后住院时间,视觉功能的恢复，术后激素水平的变化，并发症发生率,比较两组患者术后3个月并发症的恢复情况。
■肿瘤切除率无显著差异,术后视力,两组视野恢复情况比较(p>0.05)。两组术后3个月嗅觉功能恢复率比较,差异有统计学意义(p<0.05),其他并发症发生率差异无统计学意义(p>0.05);两组比较,显微镜组手术时间短,术后住院时间更长，平均手术成本更低，失血更少，差异有统计学意义(p<0.05)。鼻中隔黏膜瓣切口的位置是术后3个月发生食管炎的危险因素。
■显微手术和内镜手术是治疗非侵袭性微腺瘤和大腺瘤的合适手术方法。两种手术方式的肿瘤总切除率和术后激素缓解率大致相同。然而,显微手术组手术时间较短，术中失血少,更快的嗅觉功能恢复，和较低的平均运营成本。鼻中隔黏膜瓣切口的位置是术后3个月发生食管炎的危险因素。当鼻中隔黏膜瓣切口的上边缘不高于同侧上鼻甲的下边缘时，不太可能发生脱位。
■自2019年8月至2022年10月，选择哈尔滨医科大学附属第一医院经鼻蝶入路非侵袭性微腺瘤和大腺瘤患者93例，在垂体瘤亚专科显微镜和内镜手术方面均有丰富经验。采用不同的手术方法将患者分为显微镜组（n=35）和内镜组（n=58）。肿瘤总切除率，术中失血,运营时间和成本，术后住院时间,视觉功能的恢复，术后激素水平的变化，并发症发生率,比较两组患者术后3个月并发症的恢复情况。
■肿瘤切除率无显著差异,术后视力,两组视野恢复情况比较(p>0.05)。两组术后3个月嗅觉功能恢复率比较,差异有统计学意义(p<0.05),其他并发症发生率差异无统计学意义(p>0.05);两组比较,显微镜组手术时间短,术后住院时间更长，平均手术成本更低，失血更少，差异有统计学意义(p<0.05)。鼻中隔黏膜瓣切口的位置是术后3个月发生食管炎的危险因素。
■显微手术和内镜手术是治疗非侵袭性微腺瘤和大腺瘤的合适手术方法。两种手术方式的肿瘤总切除率和术后激素缓解率大致相同。然而,显微手术组手术时间较短，术中失血少,更快的嗅觉功能恢复，和较低的平均运营成本。鼻中隔黏膜瓣切口的位置是术后3个月发生食管炎的危险因素。当鼻中隔黏膜瓣切口的上边缘不高于同侧上鼻甲的下边缘时，不太可能发生脱位。
