Kumar S, Darr A, Hobbs C G, Carlin W V
Department of Ear, Nose and Throat, City General Hospital, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK.
J Laryngol Otol. 2012 Oct;126(10):1033-40. doi: 10.1017/S0022215112001223.
Endoscopic, transnasal management of pituitary gland neoplasms is a widely accepted alternative to the traditional microscopic approach. This study aimed to determine outcomes and complication rates for the largest UK series of endoscopic, trans-sphenoidal hypophysectomies reported to date.
We performed a retrospective analysis of 136 primary resections and 35 revision cases performed at a tertiary referral centre.
Total tumour resection was confirmed in over 85 per cent of primary and revision cases, with biochemical remission in 60 per cent. The incidence of complications such as epistaxis, sphenoid sinus problems, endocrine insufficiency, visual disturbance, post-operative haemorrhage, cranial nerve injury and mortality was significantly lower, compared with similar series using the microscopic approach.
Despite its steep 'learning curve', our series demonstrates that the endoscopic approach not only allows superior anatomical visualisation and therefore facilitates full oncological resection of tumours, but also reduces the incidence of peri-operative complications.
垂体肿瘤的内镜经鼻治疗是传统显微镜手术方法广泛接受的替代方案。本研究旨在确定英国迄今报告的最大系列内镜经蝶垂体切除术的治疗效果和并发症发生率。
我们对一家三级转诊中心进行的136例初次切除术和35例翻修手术病例进行了回顾性分析。
超过85%的初次手术和翻修手术病例实现了肿瘤全切，60%的病例实现了生化缓解。与采用显微镜手术方法的类似系列相比，鼻出血、蝶窦问题、内分泌功能不全、视力障碍、术后出血、颅神经损伤和死亡率等并发症的发生率显著更低。
尽管内镜手术存在陡峭的“学习曲线”，但我们的系列研究表明，内镜手术方法不仅能提供更好的解剖视野，从而有助于肿瘤的完整肿瘤切除，还能降低围手术期并发症的发生率。
