Evaluation of the efficacy of neuroendoscopic treatment of pituitary tumors in the elderly with different surgical approaches

doi:10.3877/cma.j.issn.2095-123X.2023.03.007

Abstract

Abstract:

Objective

To investigate the efficacy of neuroendoscopic treatment of pituitary tumors in the elderly with different surgical approaches.

Methods

Eighty-eight elderly patients with pituitary tumors admitted to the Neurosurgery Department of the People's Hospital of Danyang from March 2017 to February 2021 were selected as the study subjects, of which 5 were lost to follow-up and a total of 83 patients were included. According to the difference of treatment methods, patients were divided into two groups. Among them, 40 patients in the study group were treated with neuroendoscope through single nostril surgery, while 43 patients in the control group were treated with neuroendoscope through bilateral nostril surgery, and the differences in clinical efficacy between the two groups were compared.

Results

The operation time, hospital stay and intraoperative blood loss in the study group were significantly less than those in the control group (P<0.05), however, there was no statistically significant difference in tumor volume reduction rate and residual rate between the two groups (P>0.05). The levels of renin, angiotensin Ⅱ and norepinephrine in the study group were lower than those in the control group 3 d after operation, with a statistically significant difference (P<0.05). The tumor-related test indicators (insulin-like growth factor-1 and matrix metalloproteinase-9) of the two groups 3 d after surgery were significantly improved compared with those before surgery, with a statistically significant difference (P<0.05), but there was no statistically significant difference between the two groups (P>0.05). At 6 months after surgery, the scores of physical function, psychological function, social function, and material life function in the study group were higher than those in the control group, and the differences were statistically significant (P<0.05).

Conclusion

Neuroendoscope under the single nostril approach is more effective in the treatment of elderly pituitary tumors, which can reduce the degree of surgical stress, improve the prognosis and the quality of life of patients.

Key words: Single nostril surgical approach, Neuroendoscopy, Pituitary tumor, Outcome, Prognosis

Guangwei Sun, Changlong Hu, Tao Qiu. Evaluation of the efficacy of neuroendoscopic treatment of pituitary tumors in the elderly with different surgical approaches[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2023, 13(03): 169-174.

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References 21

[1]	顾俊怡,薛光仁,李海波,等.神经导航显微镜下经鼻蝶垂体瘤切除术的疗效观察[J].神经损伤与功能重建, 2022, 17(3): 131-134, 158. DOI: 10.16780/j.cnki.sjssgncj.20210949.
[2]	秦小春,贾琦,游洪,等.神经内镜与显微镜下经鼻蝶垂体瘤切除术治疗垂体瘤近期疗效的对比[J].吉林医学, 2022, 43(3): 629-633. DOI: 10.3969/j.issn.1004-0412.2022.03.018.
[3]	张文光,区丽琼,伍益,等.神经内镜与显微镜下经鼻蝶垂体瘤切除术的临床应用比较[J].中外医学研究, 2021, 19(7): 139-141. DOI: 10.14033/j.cnki.cfmr.2021.07.051.
[4]	王明国,乔卿均,饶克成,等.神经内镜下经单侧鼻蝶窦入路垂体腺瘤切除术治疗垂体腺瘤疗效分析[J].临床心身疾病杂志, 2022, 28(1): 139-141. DOI: 10.3969/j.issn.1672-187X.2022.01.030.
[5]	蒋文华,施晓萍,黄静,等.基于King达标理论的心理干预结合亲情干预模式对BPH患者行PKEP术后恢复情况及GQOLI-74、IPSS评分的影响[J].中国医药导报, 2020, 17(5): 164-168.
[6]	鲁彦,刘景云,张人枭.神经内镜辅助下经鼻蝶窦入路手术对垂体瘤PRL、HGH及ACTh水平的影响[J].分子诊断与治疗杂志, 2022, 14(10): 1684-1687, 1691. DOI: 10.3969/j.issn.1674-6929.2022.10.012.
[7]	谢微嫣,刘春晖,李储忠,等.神经内镜经鼻蝶切除无功能性垂体腺瘤术后复发的相关因素分析[J].中国微侵袭神经外科杂志, 2021, 26(6): 241-244. DOI: 10.11850/j.issn.1009-122X.2021.06.001.
[8]	牛国栋,袁明智,孙青青,等.内镜与显微镜下经单侧鼻蝶入路手术切除垂体腺瘤的效果和对T淋巴细胞亚群的影响[J].中国内镜杂志, 2021, 27(10): 52-61. DOI: 10.12235/E20210061.
[9]	吴波,陈崇毅,杨威,等.内镜与显微镜下经鼻蝶窦手术治疗垂体瘤的效果及对患者激素水平及视觉功能的影响[J].实用癌症杂志, 2020, 35(8): 1284-1287. DOI: 10.3969/j.issn.1001-5930.2020.08.017.
[10]	岳雄飞,默峰.神经内镜下经鼻蝶入路垂体腺瘤切除术后常见并发症的危险因素及处理方法[J].河北医科大学学报, 2020, 41(4): 487-490. DOI: 10.3969/j.issn.1007-3205.2020.04.028.
[11]	王博,王凯,靳腾龙,等.经鼻蝶入路手术在垂体瘤中的疗效分析[J].齐齐哈尔医学院学报, 2019, 40(22): 2837-2838. DOI: 10.3969/j.issn.1002-1256.2019.22.024.
[12]	郑娜,许西海.神经内镜下单鼻孔经蝶窦入路手术治疗垂体腺瘤临床观察[J].临床误诊误治, 2021, 34(10): 59-62, 67. DOI: 10.3969/j.issn.1002-3429.2021.10.014.
[13]	郭卉,黄萍,熊莉娜.不同经鼻-蝶窦入路神经内镜切除术治疗垂体瘤的安全性及有效性研究[J].中国医刊, 2021, 56(1): 56-60. DOI: 10.3969/j.issn.1008-1070.2021.01.016.
[14]	李兴辉,谭全福,朱辰路,等.神经内镜经双鼻孔入路切除侵袭性垂体腺瘤的临床疗效分析[J].临床神经外科杂志, 2021, 18(2): 196-199, 203. DOI: 10.3969/j.issn.1672-7770.2021.02.016.
[15]	呼虹宇,张天鼎,赵君爽,等.神经内镜联合多模态神经导航系统切除无功能性垂体大腺瘤的临床应用[J].中国医科大学学报, 2021, 50(8): 728-731. DOI: 10.12007/j.issn.0258-4646.2021.08.012.
[16]	邵云,浦毅,羊正祥,等.单鼻孔或双鼻孔经鼻蝶入路神经内镜手术治疗垂体瘤的效果分析[J].局解手术学杂志, 2022, 31(7): 605-608. DOI:10.11659/jjssx.11E021094.
[17]	屈浙,田军,胡昱红,等.神经内镜下经单侧鼻蝶窦入路垂体腺瘤切除术对垂体瘤病人术后血清IGF-1水平的影响[J].中西医结合心脑血管病杂志, 2019, 17(18): 2848-2850. DOI: 10.12102/j.issn.1672-1349.2019.18.034.
[18]	李承科,何琴,唐辉,等.垂体腺瘤术后外周血T淋巴细胞亚群及血清MMP-9水平的变化[J].中国临床神经外科杂志, 2018, 23(2): 87-89. DOI: 10.13798/j.issn.1009-153X.2018.02.008.
[19]	张国栋,赵岗,师鹏强,等.神经内镜下"一侧半"经鼻-蝶窦入路切除术对高龄垂体瘤患者的疗效及术后复发的危险因素[J].中国老年学杂志, 2021, 41(3): 509-513. DOI: 10.3969/j.issn.1005-9202.2021.03.018.
[20]	王建飞,石东付,卢国奇,等.经鼻蝶入路神经内镜手术和显微手术治疗垂体腺瘤的疗效[J].中国临床神经外科杂志, 2021, 26(2): 117-118. DOI: 10.13798/j.issn.1009-153X.2021.02.017.
[21]	王纵.经鼻孔蝶窦入路神经内镜下垂体瘤切除术对老年垂体瘤患者预后的影响[J].中国实用神经疾病杂志, 2019, 22(9): 981-987. DOI: 10.12083/SYSJ.2019.09.281.

项目	对照组（n=43）	研究组（n=40）	t/χ²值	P值
性别			0.885	0.347
男	33	29
女	10	11
年龄（岁，Mean±SD）	72.2±6.5	71.5±6.1	0.505	0.615
病程（年，Mean±SD）	4.9±0.7	5.2±0.8	0.245	0.807
肿瘤平均直径（mm，Mean±SD）	20.5±2.8	19.8±2.6	1.178	0.242
体质量指数（kg/m²，Mean±SD）	22.2±3.6	22.5±3.8	0.369	0.713
肿瘤类型			0.988	0.912
生长激素腺瘤	7	5
泌乳素腺瘤	15	16
促肾上腺皮脂腺瘤	8	5
无功能腺瘤	13	14
糖尿病	11	12	0.202	0.653
高血压	17	15	0.036	0.849
高血脂	9	7	0.157	0.692

项目	对照组（n=43）	研究组（n=40）	t/χ²值	P值
性别			0.885	0.347
男	33	29
女	10	11
年龄（岁，Mean±SD）	72.2±6.5	71.5±6.1	0.505	0.615
病程（年，Mean±SD）	4.9±0.7	5.2±0.8	0.245	0.807
肿瘤平均直径（mm，Mean±SD）	20.5±2.8	19.8±2.6	1.178	0.242
体质量指数（kg/m²，Mean±SD）	22.2±3.6	22.5±3.8	0.369	0.713
肿瘤类型			0.988	0.912
生长激素腺瘤	7	5
泌乳素腺瘤	15	16
促肾上腺皮脂腺瘤	8	5
无功能腺瘤	13	14
糖尿病	11	12	0.202	0.653
高血压	17	15	0.036	0.849
高血脂	9	7	0.157	0.692

组别	例数	手术时间（min，Mean±SD）	住院时间（d，Mean±SD）	术中出血量（mL，Mean±SD）	肿瘤体积缩小率（%，Mean±SD）	肿瘤残留率[例（%）]
对照组	43	124.2±19.8	11.5±3.4	100.3±8.2	91.2±9.0	4（9.3）
研究组	40	83.5±15.4	6.2±1.1	51.6±4.2	92.6±10.4	3（7.5）
t/χ²值		4.669	3.391	4.995	1.228	0.087
P值		0.033	0.036	0.026	0.259	0.769

组别	例数	手术时间（min，Mean±SD）	住院时间（d，Mean±SD）	术中出血量（mL，Mean±SD）	肿瘤体积缩小率（%，Mean±SD）	肿瘤残留率[例（%）]
对照组	43	124.2±19.8	11.5±3.4	100.3±8.2	91.2±9.0	4（9.3）
研究组	40	83.5±15.4	6.2±1.1	51.6±4.2	92.6±10.4	3（7.5）
t/χ²值		4.669	3.391	4.995	1.228	0.087
P值		0.033	0.036	0.026	0.259	0.769

项目	对照组(n=43)				研究组(n=40)
项目	术前	术后3 d	t值	P值	术前	术后3 d	t值	P值
AngⅡ(pg/mL)	17.3±3.8	45.9±5.9	26.724	<0.001	16.5±3.4	26.0±5.2^a	9.671	<0.001
R(pg/mL)	1.6±0.3	5.5±1.2	20.675	<0.001	1.5±0.4	2.3±0.8^a	5.657	<0.001
NE(ng/mL)	82.7±12.0	188.0±19.5	30.157	<0.001	82.5±11.8	112.2±15.3^a	9.723	<0.001

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