| Background and objective: at present,pituitary tumor is mainly treated bysurgery.Fromcraniotomy in the past totranssphenoidalapproachat the time being,curative effect has been improved significantly,especially ofthe application of neuroendoscope which makestranssphenoidal surgery of pituitary adenoma to be minimally invasive,with better clinical effect.Compared with microscopic transsphenoidal approach,neuroendoscope has many advantagesin the treatment of pituitary adenomas.With increasing application of neuroendoscopein recent years,the reports on the treatment of pituitary adenomas by neuroendoscopic surgery and microscopic surgery have been on the increase.Neuroendoscopic surgery has better curative effect,less invasion,easier operation,with lower complications.It is a kind of minimally invasive neurosurgerytechnique.Research method and process:a total of 121 patients who wereadmitted due topituitary adenoma and underwent transsphenoidal approach to remove pituitary tumorsin the department of Neurosurgery ? of China-JapanUnionHospitalofJilin University from January 2014 to October 2016 were included into the study,and the pathology of all patients were confirmed to be pituitary adenoma according to postoperative pathological report.61 patients underwent neuroendoscopic surgery and 60 underwent the microscopic surgery.All of the patients were the first to undergosurgeries and not treated with drugs or radiation therapy.There were 22 males and 39 females in the neuroendoscopic surgery group,with the average age of 48.6 years old and average duration of 18.9 months;there were 25 males and 35 females in the microscopic surgery group,with the average age of 45.5 years old and average duration of 16.8 months.Preoperative basic data,imaging and endocrine examination results,clinical symptoms,postoperative hospitalization time,relief of symptom,hormone recovery and complicationsof patients,such as cerebrospinal rhinorrhea,intracranial hematoma,intracranial infection,low pituitary function,epistaxis and nasal obstruction,diabetes insipidus,were collected in a comprehensive way.The data were preliminarilyorganized and summarized by Eecel 2007 and analyzed by SPSS22.0 software,and x? s was used to represent main measurement data presentingnormal distribution,and M(Q25~Q75)to represent those not presentingnormal distribution.T test was applied ifthe comparison of measurement data between the two groups presented normal distribution,andnon-parametric rank sum test(Kruskal-WallisTest)was employed if the two groups did notpresent normal distribution.Pearson chi square test was performed to the comparisons of all count data.?=0.05 was considered to be statistically significant.Complications after neuroendoscopictranssphenoidal approach and microscopic transsphenoidal approach to remove pituitary adenomawere analyzed,to find the difference between the two surgeries,so as to provide reference for transsphenoidal pituitary adenomas resection.Research results: by comparing and analyzing postoperative complications,it was found that the incidence rates of complications in the neuroendoscopic surgery group were lower than those in the microscopic surgery group,and the difference was significant(P<0.05).Incidence rates ofpostoperative hypopituitarism,nasal diseases and insipidus in the neuroendoscopic surgery group were lower than those in the microscopic surgery group,with significantly statistical difference(P<0.05).However,endoscopic technique has more obvious advantages mainly in flexibility.Neuroendoscopic surgery dispenses with nasal speculum,so it is applicable to wide-angle panoramic surgery and more close to the target,gaining a clear understanding of anatomic structures of sellar region,and better identifying bilateral internal carotidartery uplifts and optic nerveprocess normal pituitary,to avoid of removing normal pituitary tissues andbringing serious damage to normal tissues.Due to small cross section and small size ofneuroendoscopic lens,neuroendoscope is easier to operate in narrow spacescompared to microscope,and in the meanwhile ofdispensing with the removal of turbinate structure and only requiring a piece of cotton to openturbinate structure.Microscopeis less flexible,as it is only applicable to certain kinds of spaces.Neuroendoscopic surgical treatment is performed along patient's nasal passages through to cut mucosa,which does need toopen septum bone and cartilage,so patients recover more rapidly.Conclusion: the single center clinical trial was described by the summary and analysis ofabove research results.Although the surgical samples collected in the retrospective case study was few,the complications afternuroendoscopic surgery and microscopic surgery in the treatment of pituitary adenoma were generally similar.However,nuroendoscopic surgeryhad obvious advantages in complications compared with microscopic surgery.The reason is that surgeonsand their assistants havereceived systematic training in nuroendoscopic surgery,so theyare skillfully in thetechnique.The intraoperative bleeding was less,the length of stay was shorter and the risk of surgical complications was lower in the transsphenoidal pituitary adenoma sur gery neuroendoscopy group,compared with those in microscope group.And there we re no significant differences in the incidences of cerebrospinal fluid leakage and intrac ranial infection,but the incidences of postoperative pituitary insufficiency,diabetes in sipidus,postoperative nasal congestion and nasal bleeding were low.Compared with microscopic transsphenoidal surgery in the treatment of pituitary adenoma,nuroendoscopic surgical treatment dispenses with nasal speculum,soit can better protect normal structure of nasal cavity.With more clear and widervision,nuroendoscope can observe deep into operation field,to gain clear understanding towards the resection of pituitary adenoma.It can alsocompletely resectpituitary adenoma,control the damages to normal pituitary and peripheral tissues,so as to enhance the safety and effectiveness of the surgery,reduce the probability of complications and shorten hospitalization time.All in all,nuroendoscopictranssphenoidal surgery has very obviousadvantages in the treatment of pituitary adenoma.As an ideal neurosurgerytechnique,nuroendoscopictranssphenoidal surgeryshould be applied extensively. |
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