神经内镜与显微镜下经鼻蝶入路手术切除垂体腺瘤的临床疗效比较及术中出现脑脊液漏的危险因素分析

摘要 目的：对比垂体腺瘤患者采用显微镜或神经内镜下经鼻蝶入路手术切除后的临床疗效，分析术中出现脑脊液漏的危险因素。方法：回顾性分析2018年3月~2022年2月期间来我院接受手术治疗的178例垂体腺瘤患者的临床资料。根据采用手术器械的不同将178例患者分为A组（显微镜，n=91）和B组（神经内镜，n=87）。比较两组的肿瘤有效切除率、临床指标、术中脑脊液漏发生率及术后并发症发生率。根据术中是否发生脑脊液漏分为脑脊液漏组和无脑脊液漏组。经单因素和多因素Logistic回归分析患者术中发生脑脊液漏的危险因素。结果：B组的手术时间、住院时间短于A组，术中出血量少于A组（P<0.05）。A组、B组的肿瘤有效切除率组间对比，无统计学差异（P>0.05）。B组术中脑脊液漏发生率、术后并发症发生率低于A组（P<0.05）。垂体腺瘤患者术中发生脑脊液漏与再次手术、肿瘤大小、年龄、肿瘤质地、美国麻醉医师协会（ASA）分级有关（P<0.05）。肿瘤大小为巨大腺瘤、再次手术、肿瘤质地为韧是垂体腺瘤患者术中发生脑脊液漏的危险因素（P<0.05）。结论：显微镜与神经内镜下经鼻蝶入路手术切除垂体腺瘤，治疗效果相当，但神经内镜下手术可缩短手术时间、住院时间，减少术中出血量，降低术中脑脊液漏发生率、术后并发症发生率。此外，肿瘤大小为巨大腺瘤、再次手术、肿瘤质地为韧是垂体腺瘤患者术中发生脑脊液漏的危险因素。

Comparison of Clinical Efficacy between Neuroendoscope and Microscope Transsphenoidal Approach Surgery for Pituitary Adenomas and Analysis of Risk Factors of Cerebrospinal Fluid Leakage during Operation

ABSTRACT Objective: To compare the clinical efficacy of microscope or neuroendoscope transsphenoidal approach surgery for patients with pituitary adenomas, and to analyze the risk factors of cerebrospinal fluid leakage during operation. Methods: The clinical data of 178 patients with pituitary adenomas who underwent surgery in our hospital from March 2018 to February 2022 were retrospectively selected. 178 patients were divided into group A (microscope, n=91) and group B (neuroendoscope, n=87) according to different surgical instruments. The effective tumor resection rate, clinical indicators, the incidence of cerebrospinal fluid leakage during operation and the incidence of postoperative complications were compared between the two groups. According to whether cerebrospinal fluid leakage occurred during operation, it was divided into cerebrospinal fluid leakage group and no cerebrospinal fluid leakage group. The risk factors of cerebrospinal fluid leakage during operation were analyzed by univariate and multivariate Logistic regression. Results: The operation time and hospital stay of the group B were shorter than those of the group A, and the amount of intraoperative bleeding was less than that of the group A (P<0.05). There was no significant difference in the effective tumor resection rate between group A and group B (P>0.05). The incidence of cerebrospinal fluid leakage during operation and postoperative complications of the group B were lower than those of the group A (P<0.05). Cerebrospinal fluid leakage during operation in patients with pituitary adenoma was related to reoperation, tumor size, age, tumor texture, American Association of anesthesiologists (ASA) grade (P<0.05). The tumor size was huge adenoma, reoperation, and the tumor texture was tough were the risk factors for cerebrospinal fluid leakage during operation in patients with pituitary adenoma (P<0.05). Conclusion: Microscopeand neuroendoscope transsphenoidal surgery for pituitary adenomas has the same therapeutic effect, but neuroendoscope surgery can shorten the operation time, hospital stay, reduce the amount of intraoperative bleeding, reduce the incidence of cerebrospinal fluid leakage during operation and postoperative complications. In addition, the tumor size is huge adenoma, reoperation, and the tumor texture is tough are the risk factors of cerebrospinal fluid leakage during operation in patients with pituitary adenoma.