Clinical observation of pituitary adenomas with microscope surgery by single nostril transsphenoidal approach / 中国基层医药

ABSTRACT

Objective To compare the two kinds of the single nostril transsphenoidal approach of minimally invasive surgery of pituitary adenoma and analyze the clinical data ,and then provide references for clinical diagnosis and treatment .Methods The prospective study methods were used in the study .A total of 54 cases of pituitary tumor patients were collected , they were randomly divided into microscope group ( 31 cases ) and neural endoscopic group (23 cases).The operation time,intraoperative blood loss,hospital stay,the resection rate,postoperative complications ( mainly observed transient postoperative insipidus and transient electrolyte disorder ) , the hormone levels , and the comparison the results of patients ,follow-up within 1 year were observed .Results The operation time of microscope group(121.3+19.4)min was longer than that of the neuroendoscopic group (78.5 ±7.8)ml,but the intraoperative blood loss in the microscope group was less than that of the neuroendoscopic group [(50.3 ±3.2) mL vs (78.5 ± 7.8)mL,t=0.993,1.032,all P>0.05].The postoperative hospital stay [(8.7 +1.1) d vs (9.1 +2.3) d,t=2.897,P>0.05],the resection rate(93.5% vs 91.3%,χ2 =3.191,P>0.05) had no significant differences be-tween the two groups .The postoperative complications ( including transient insipidus and transient electrolyte disorder ) also had no obvious differences .The analysis of the endocrine hormone levels of different tumors found that there were no significant differences between the microscope group and neuroendoscopic group .The levels of these pre operative and postoperative hormones were as followsPRL[(387.3 ±100.8)μg/L vs (145.3 ±27.4)μg/L and (390.2 ± 133.7)μg/L vs (148.4 ±57.2)μg/L],GH[(63.4 ±5.7)μg/L vs (10.6 ±2.4)μg/L and (65.6 ±6.2)μg/L vs (12.4 ±1.6)μg/L],ACTH[(202.9 ±73.7)ng/L vs (38.5 ±4.6)ng/L and (206.8 ±78.6)ng/L vs (35.6 ± 2.5)ng/L],they all had significant differences (t =1.456,1.301,0.973,1.034,0.774,0,732,all P <0.05). Conclusion The curative effects of the two surgical treatment of pituitary adenoma have no obvious differences ,they have advantages of minimally invasive , safe and effective, but the microscopic surgery has less bleeding , while neuroendoscopic surgery can shorten the operation time .