内镜经鼻蝶入路手术治疗不同 Knosp 分级垂体瘤的疗效分析

摘要

Objective To explore the efficacy of extended endoscopic endonasal transsphenoidal approach(EEETA) for removal of different Knosp grades pituitary tumors.Methods The clinical data of 92 patients admitted to the Affiliated Hospital of Xuzhou Medical University from September 2016 to March 2018 that underwent removal of pituitary tumors in different Knosp grades via endoscopic endonasal transsphenoidal approach were analyzed retrospectively .The resection rate, clinical cured rate and complications in different Knosp grades pituitary tumors were compared and analyzed.Results Gross total resection ( GTR ) were achieved in 69 patients, and near-total resection in 17, sub-total resection in 5 and partial resection in 1.The rate of GTR in different Knosp classifications were significantly different , the rate of gross total resection in Knosp grades 0-2 patients(90.5%) was statistically higher than Knosp grades 3 -4 (41.4%) ( P＜0.05).The rate of complications in Knosp grade 0 -2 patients was statistically lower than that of grade 3 -4 patients,and there was no significant difference in the total cure rate of postoperative hormone levels in patients with Knosp grade 0-2 and grade 3-4 functional pituitary tumors.Conclusion Endoscopic endonasal transsphenoidal approach is a safe and effective method for resection of suprasellar pituitary tumors,especially for patients with grade 0-2.%目的 探讨内镜经鼻蝶扩大入路手术治疗不同Knosp分级垂体瘤的临床疗效.方法 回顾性分析徐州医科大学附属医院神经外科自2016年9月—2018年2月,应用内镜经鼻蝶扩大入路手术治疗92例不同Knosp分级垂体瘤患者的临床资料;比较不同Knosp分级患者的垂体瘤切除程度及并发症发生率及功能型垂体瘤患者激素水平缓解情况.结果 本组患者中全切者69例,近全切患者17例,次全切患者5例,部分切除患者1例;Knosp分级0～2级垂体瘤患者的全切率(90.5%)明显高于Knosp分级3～4级患者(41.4%),差异具有统计学意义(P＜0.05). Knosp分级0～2级患者的手术并发症发生率明显低于3～4级患者;Knosp分级0～2级和3～4级功能型垂体瘤患者的术后激素水平总的治愈率无明显差异.结论 内镜经鼻蝶扩大入路治疗不同Knosp分级垂体瘤是一种安全、有效的手术方法,尤其是对于Knosp分级0～2级的患者.