Department of Neurosurgery, Cedars-Sinai Medical Center, 8631 W. Third St., Ste. 800E, Los Angeles, CA 90048, USA.
Pituitary. 2013 Sep;16(3):393-401. doi: 10.1007/s11102-012-0437-1.
The objective of this study was to evaluate outcomes of endoscopic transsphenoidal surgery using a single-surgeon technique as an alternative to the more commonly employed two-surgeon, three-hand method. Three hundred consecutive endoscopic transsphenoidal procedures performed over a 5 year period from 2006 to 2011 were reviewed. All procedures were performed via a binasal approach utilizing a single surgeon two handed technique with a pneumatic endoscope holder. Expanded enodnansal cases were excluded. Surgical technique, biochemical and surgical outcomes, and complications were analyzed. 276 patients underwent 300 consecutive surgeries with a mean follow-up period of 37 ± 22 months. Non-functioning pituitary adenoma (NFPA) was the most common pathology (n = 152), followed by growth hormone secreting tumors (n = 41) and Rathke's cleft cysts (n = 30). Initial gross total cyst drainage based on radiologic criteria was obtained in 28 cases of Rathke's cleft cyst, with 5 recurrences. For NFPA and other pathologies (n = 173) gross total resection was obtained in 137 cases, with a 92% concordance rate between observed and expected extent of resection. For functional adenoma, remission rates were 30/41 (73%) for GH-secreting, 12/12 (100%) for ACTH-secreting, and 8/17 (47%) for prolactin-secreting tumors. Post-operative complications included transient (11%) and permanent (1.4%) diabetes insipidus, hyponatremia (13%), and new anterior pituitary hormonal deficits (1.4%). CSF leak occurred in 42 cases (15%), and four patients required surgical repair. Two carotid artery injuries occurred, both early in the series. Epistaxis and other rhinological complications were noted in 10% of patients, most of which were minor and diminished as surgical experience increased. Fully endoscopic single surgeon transsphenoidal surgery utilizing a binasal approach and a pneumatic endoscope holder yields outcomes comparable to those reported with a two-surgeon method. Endoscopic outcomes appear to be better than those reported in microscope-based series, regardless of a one or two surgeon technique.
本研究旨在评估使用单外科医生技术进行内镜经蝶窦手术的结果，作为更常用的双外科医生、三手方法的替代方法。对 2006 年至 2011 年 5 年内连续进行的 300 例内镜经蝶窦手术进行了回顾性分析。所有手术均通过鼻内途径，采用单外科医生双手技术和气动内镜固定器进行。排除扩展内镜经蝶窦病例。分析手术技术、生化和手术结果以及并发症。276 例患者接受了 300 例连续手术，平均随访时间为 37 ± 22 个月。无功能垂体腺瘤（NFPA）是最常见的病理类型（n = 152），其次是生长激素分泌肿瘤（n = 41）和 Rathke 裂隙囊肿（n = 30）。根据影像学标准，28 例 Rathke 裂隙囊肿获得了初始的大体全切囊肿引流，其中 5 例复发。对于 NFPA 和其他病理类型（n = 173），在 137 例中获得了大体全切，观察到的和预期的切除范围之间的一致性为 92%。对于功能性腺瘤，生长激素分泌肿瘤的缓解率为 30/41（73%），ACTH 分泌肿瘤为 12/12（100%），催乳素分泌肿瘤为 8/17（47%）。术后并发症包括短暂性（11%）和永久性（1.4%）尿崩症、低钠血症（13%）和新的前垂体激素缺乏症（1.4%）。CSF 漏发生在 42 例（15%）中，其中 4 例需要手术修复。发生了 2 例颈动脉损伤，均发生在早期系列中。10%的患者出现鼻出血和其他鼻科并发症，大多数为轻微，随着手术经验的增加而减少。使用鼻内途径和气动内镜固定器的单外科医生全内镜经蝶窦手术的结果与双外科医生方法报告的结果相当。无论采用单外科医生还是双外科医生技术，内镜结果似乎都优于显微镜系列报告的结果。
