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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2025, Vol. 11 ›› Issue (03) : 154 -159. doi: 10.3877/cma.j.issn.2095-9141.2025.03.003

临床研究

经鼻蝶神经内镜下功能性垂体瘤切除术的疗效分析
王瀚, 易勇, 周世军, 杨学芳, 江竟成, 邓青山†()   
  1. 644000　四川宜宾，宜宾市第二人民医院（四川大学华西医院宜宾医院）神经外科
  • 收稿日期:2025-01-01 出版日期:2025-06-15
  • 通信作者: 邓青山

Analysis of the therapeutic effect of transsphenoidal neuroendoscopic resection of functional pituitary adenoma

Han Wang, Yong Yi, Shijun Zhou, Xuefang Yang, Jingcheng Jiang, Qingshan Deng†()   

  1. Department of Neurosurgery, the Second People's Hospital of Yibin, West China Hospital, Sichuan University, Yibin 644000, China
  • Received:2025-01-01 Published:2025-06-15
  • Corresponding author: Qingshan Deng
  • Supported by:
    Yibin Municipal Health Commission Research Project(2019YW020)
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王瀚, 易勇, 周世军, 杨学芳, 江竟成, 邓青山. 经鼻蝶神经内镜下功能性垂体瘤切除术的疗效分析[J/OL]. 中华神经创伤外科电子杂志, 2025, 11(03): 154-159.

Han Wang, Yong Yi, Shijun Zhou, Xuefang Yang, Jingcheng Jiang, Qingshan Deng. Analysis of the therapeutic effect of transsphenoidal neuroendoscopic resection of functional pituitary adenoma[J/OL]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2025, 11(03): 154-159.

目的

探讨经鼻蝶神经内镜下功能性垂体瘤切除术的疗效，分析术后垂体激素水平变化及对视觉功能的影响。

方法

回顾性分析宜宾市第二人民医院神经外科自2018年4月至2022年4月行手术治疗的58例功能性垂体瘤患者的临床资料，根据手术方式的不同，将经鼻蝶显微镜下垂体瘤切除的28例患者纳入对照组，经鼻蝶神经内镜下垂体瘤切除的30例患者纳入研究组。分析2组患者手术前后垂体激素水平和视觉功能的变化，比较2组患者的手术时间、术中出血量、术后住院时间、复发率及肿瘤切除率。

结果

研究组患者中生长激素（HGH）瘤患者术后的HGH水平、视野模式标准差、视野平均缺损均低于对照组，视野指数高于对照组，差异均有统计学意义（P<0.05）。研究组患者的手术时间、术后住院时间、肿瘤复发率均低于对照组，肿瘤全切率高于对照组，差异均有统计学意义（P<0.05）。2组患者中泌乳素（PRL）瘤患者术后的PRL水平、促肾上腺皮质激素（ACTH）瘤患者术后的ACTH水平及2组患者术中出血量比较，差异均无统计学意义（P>0.05）。

结论

经鼻蝶神经内镜下手术治疗功能性垂体瘤疗效确切，在降低HGH水平、改善视觉功能及提高肿瘤全切率方面具有优势。

关键词: 功能性垂体瘤, 经鼻蝶神经内镜手术, 经鼻蝶显微镜手术, 激素水平, 视觉功能
Objective

To investigate the efficacy of transsphenoidal endoscopic functional pituitary tumor resection, and to analyze the postoperative changes in pituitary hormone levels and their impact on visual function.

Methods

A total of 58 patients with functional pituitary tumors who underwent surgical treatment at Neurosurgery Dpartment of Yibin Second People's Hospital from April 2018 to April 2022 were retrospectively analyzed. According to different surgical methods, the control group (n=28) underwent transsphenoidal microscopic pituitary tumor resection, while the study group (n=30) underwent transsphenoidal neuroendoscopic pituitary tumor resection. Pituitary hormone levels, visual function, surgical time, intraoperative blood loss, postoperative hospital stay, recurrence rate, and resection rate were compared between the two groups.

Results

The postoperative levels of human growth hormone (HGH) in patients with HGH tumors, pattern standard deviation of visual field, and mean deviation of visual field in the study group were significantly lower than those in the control group, while the visual field indexwas significantly higher than that in the control group (P<0.05). The study group also demonstrated shorter surgical duration, reduced postoperative hospital stay, and lower tumor recurrence rates compared to the control group, with a higher total tumor resection rate compared to the control group (P<0.05). However, no statistically significant differences were observed between the two groups in postoperative prolactin levels among prolactinoma patients, postoperative adrenocorticotropic hormone levels among adrenocorticotropic hormone patients, or intraoperative blood loss (P>0.05).

Conclusions

Transsphenoidal neuroendoscopic resection is effective for functional pituitary adenomas, offering significant advantages in reducing serum growth hormone levels, improving visual function, and increasing the gross-total resection rate.

Key words: Functional pituitary adenoma, Transsphenoidal neuroendoscopic resection, Microscopic transsphenoidal surgery, Hormone levels, Visual function
图1 显微镜下与内镜下经鼻蝶垂体瘤切除的示意图及典型患者术前术后影像资料A~D：神经内镜下经鼻蝶垂体瘤切除术；A：示意图；B：内镜下磨除蝶窦骨质暴露垂体瘤；C：术前垂体MRI矢状位；D：术后垂体MRI复查影像；E~H：显微镜下经鼻蝶垂体瘤切除术；E：示意图；F：术中扩鼻器建立手术通道；G：术前垂体MRI矢状位；H：术后垂体MRI复查影像
Fig.1 Schematic illustrations of transnasal transsphenoidal pituitary tumor resection under microscope and endoscope of pituitary adenomas, accompanied by representative pre- and post-operative imaging of typical patients
表1 2组垂体瘤患者一般资料比较
Tab.1 Comparison of general data of two groups of pituitary tumor patients
组别 例数 性别（男/女） 年龄（岁，±s） 平均病程（年，±s） 瘤体直径（cm，±s）
对照组 28 18/10 48.4±10.9 2.3±0.3 2.2±0.5
研究组 30 17/13 51.8±11.9 2.2±0.4 2.0±0.4
χ2/t值   0.351 -1.134 1.362 0.878
P值   0.553 0.261 0.179 0.384
表2 2组垂体瘤患者术前术后血清HGH、ACTH、PRL水平比较[M（P25，P75）]
Tab.2 Comparison of serum levels of HGH, ACTH, and PRL between two groups of pituitary tumor patients before and after surgery [M(P25,P75)]
激素 组别 例数 术前 术后 V值 P值
HGH（ng/mL） 对照组 10 7.94(5.76，8.69) 2.91(1.82，4.36) 55.000 0.002
研究组 12 7.55(6.07，9.07) 1.53(0.52，1.56) 66.000 <0.001
U值   47.500 29.000    
P值   0.699 0.028    
ACTH（pg/mL） 对照组 5 93.39(93.26，99.96) 17.05(12.75，17.63) 15.000 0.043
研究组 4 90.22(83.26，103.26) 13.00(12.05，16.04) 10.000 0.043
U值   7.500 6.000    
P值   0.486 0.343    
PRL（mIU/L） 对照组 13 3245.50(2345.67，3675.80) 564.65(376.65，700.65) 91.000 <0.001
研究组 14 3187.65(2923.46，4174.65) 516.79(423.46，620.99) 91.000 <0.001
U值   75.500 69.000    
P值   0.793 0.486    
表3 2组垂体瘤患者术前术后视觉功能比较（±s）
Tab.3 Comparison of visual function between two groups of pituitary tumor patients before and after surgery (Mean±SD)
指标   对照组（n=28） 研究组（n=30） t值 P值
VFI（%） 术前 66.5±9.0 67.4±8.3 -0.397 0.693
术后 80.4±4.5 83.3±3.5 -2.780 0.007
t值 -7.319 -9.691    
P值 <0.001 <0.001    
PSD（dB） 术前 9.0±2.2 7.8±2.9 1.677 0.099
术后 3.7±0.5 2.4±0.4 10.778 <0.001
t值 12.540 10.043    
P值 <0.001 <0.001    
MD（dB） 术前 -10.8±3.0 -11.4±3.5 0.665 0.509
术后 -5.4±0.8 -3.0±0.3 -16.249 <0.001
t值 -9.176 -13.047    
P值 <0.001 <0.001    
表4 2组垂体瘤患者术中出血量、手术时间及术后住院时间比较[M（P25，P75）]
Tab.4 Comparison of intraoperative blood loss, operation time and postoperative hospital stay between the two groups of pituitary tumor patients [M(P25，P75)]
组别 例数 术中出血量（mL） 手术时间（min） 术后住院时间（d）
对照组 28 135（90，170） 188（162，234） 9（7，10）
研究组 30 120（97.5，162.5） 145（133，189） 6（5，7）
Z值   -0.979 -3.129 -5.019
P值   0.328 0.002 <0.001
表5 2组垂体瘤患者复发率与切除率比较[例（%）]
Tab.5 Comparison of recurrence rate and resection rate between two groups of pituitary tumor patients [n(%)]
组别 例数 复发率 切除率
部分切除 次全切 全切
对照组 28 8（28.6） 3（10.7） 7（25.0） 18（64.3）
研究组 30 1（3.3） 1（3.3） 2（6.7） 27（90.0）
χ2/Z值   7.037 -2.300
P值   0.008 0.021
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