临床肿瘤学杂志

目的 基于应激反应、嗅觉功能及视觉功能变化探讨垂体腺瘤患者经神经内镜下不同入路手术治疗的效果。方法 回顾性分析2021年1月至2023年9月在河南科技大学第一附属医院接受治疗的102例垂体腺瘤患者的临床资料,依据治疗方法分为A组(53例)和B组(49例)。A组给予神经内镜下经鼻腔蝶窦入路手术治疗,B组给予神经内镜下经鼻中隔黏膜下蝶窦入路手术治疗。术后随访6个月,对两组手术指标、嗅觉功能、视觉功能、应激反应、基质金属蛋白酶-9(MMP-9)、胰岛素样生长因子-1(IGF-1)、沉默信息调节因子1(SIRT1)、缺氧诱导因子-1α(HIF-1α)和并发症进行比较。结果 与A组比较,B组术中出血量及鼻甲折断/切除占比更低、手术及术后住院的时间均更短(P<0.05),而A组和B组肿瘤全切占比的差异无统计学意义(P>0.05)。术后6个月,两组五味试嗅液测试分值均高于术后3个月(P<0.05);A组术后6个月低于术前(P<0.05);术后3个月,两组五味试嗅液测试分值均低于术前;术后3、6个月,B组高于A组(P<0.05)。与术前比较,术后1个月两组视野模式标准差(PSD)均降低,视野指数(VFI)、视野平均缺损(MD)值均升高(P<0.05),但以上指标A、B两组比较差异无统计学意义(P>0.05)。两组术后1 d的应激指标较术前均升高(P<0.05),B组比A组低。两组术后1 d的血清MMP-9、IGF-1、SIRT1、HIF-1α水平较术前均降低(P<0.05),但A、B两组比较差异无统计学意义(P>0.05)。A组和B组随访期间的并发症发生率比较,差异无统计学意义(P>0.05)。结论 两种手术入路治疗垂体腺瘤均可取得较好的肿瘤切除效果,并调节患者血清MMP-9、IGF-1、SIRT1、HIF-1α水平,对患者视觉功能的影响差别不大,且安全性良好,但经鼻中隔黏膜下蝶窦入路在减少术中出血量、鼻甲折断/切除情况、缩短手术和住院时间及对患者嗅觉功能、应激反应的影响方面较有优势。

Objective To explore the therapeutic effects of different endoscopic approaches for patients with pituitary adenoma based on stress response, changes in olfactory function and visual function. Methods The research subjects were selected from 102 patients with pituitary adenoma who received treatment at the First Affiliated Hospital of Henan University of Science and Technology from January 2021 to September 2023, and their clinical data were retrospectively analyzed. According to treatment methods,102 patients were divided into group A(53 cases) and group B(49 cases). The group A was treated with neuroendoscopic transnasal-sphenoid sinus approach, and the group B was treated with neuroendoscopic transnasal submucous sphenoid sinus approach.The postoperative follow-up time was 6 months. The surgical indexes, including olfactory function, visual function, stress response and matrix metalloproteinase 9(MMP-9), insulin-like growth factor 1(IGF-1), silent information regulator1(SIRT1), hypoxia inducible factor-1(HIF-1α), and complications during follow-up were compared. Results Compared with the group A, the amount of intraoperative blood loss and proportion of turbinate fracture/resection in the group B were lower, the times of surgery and postoperative hospital stay were shorter(P<0. 05), while there was no difference of the proportion of total resection of tumors in group A and group B(P>0. 05). 6 months after surgery. The scores in the five flavor odor test of both groups at 6 months after surgery were higher than 3 months after surgery(P<0. 05), while group A had lowers cores at 6 months after surgery than before surgery(P<0. 05). At 3months after surgery, the scores of the five flavor odor test in both groups were lower than before surgery, and group B at 3 and 6months after surgery was higher than group A(P< 0. 05). Compared with the preoperative results, at 1 month after surgery, the standard deviation of visual field pattern(PSD) were decreased, the visual field index(VFI) and mean visual field defect(MD) were increased in both groups(P<0. 05), but there was no difference between the two groups(P>0. 05). Compared with before surgery,the levels of stress indicators at 1 d after surgery were all increased in two groups, but compared with the group A, those in group B were lower(P<0. 05). Compared with before surgery, the levels of serum MMP-9, IGF-1, SIRT1, and HIF-1 α at 1 d after surgery were decreased in both groups(P<0. 05), but there was no significant difference between the two groups(P>0. 05). There was no difference of the incidence of complications during the follow-up period between the group A and the group B(P>0. 05). Conclusion Both approaches for treating pituitary adenoma could achieve good tumor resection results and regulate the levels of serum MMP-9,IGF-1, SIRT1, and HIF-1 α in patients. The impact on patients′ visual function was not significantly different, and the safety was good. However, the submucosal sphenoid sinus approach through the nasal septum had advantages in reducing intraoperative bleeding,nasal nail breakage/resection, shortening surgery and hospitalization time, and affecting patients′ olfactory function and stress response.