Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
J Clin Endocrinol Metab. 2013 Aug;98(8):3190-8. doi: 10.1210/jc.2013-1036. Epub 2013 Jun 4.
It is unclear whether endoscopic transsphenoidal surgery (ETSS) or microsurgical transsphenoidal surgery (MTS) is a superior surgical approach for pituitary adenomas.
The objective of the study was to compare the outcome of surgery with ETSS and MTS by experienced pituitary surgeons using criteria of remission using current consensus criteria for acromegaly.
This was a retrospective review of prospectively recorded outcomes. The study was conducted at a tertiary referral center. Patients, Interventions, and Outcome Measures: Remission was defined as a normal IGF-I level and either suppressed GH less than 0.4 ng/mL during an oral glucose tolerance test or random GH less than 1.0 ng/mL. The Youden indices were calculated to determine the optimal cutoffs for using immediate postoperative GH levels to predict the results of later testing for remission.
Preoperative demographics and tumor characteristics were not significantly different between patients undergoing ETSS (72 patients) or MTS (41 patients). Overall, postoperative remission was achieved in 20 of 23 microadenomas (87%) and 59 of 90 macroadenomas (66%). Remission rates and perioperative complications were not significantly different between ETSS and MTS groups, except for self-reported sinusitis and alterations in taste or smell, which were significantly higher in patients treated with ETSS. Preoperative variables predicting remission in multivariate analysis included GH less than 45 ng/mL [odds ratio (OR) 6.4, P = .010)] and Knosp score of 0-2 (OR 6.8, P < .001). Postoperative in-hospital GH less than 1.15 ng/mL provided the best predictor of remission (OR 7.7, P < .001; sensitivity of 73%, specificity of 85%) defined by follow-up testing.
Outcomes of transsphenoidal surgery for acromegaly by experienced pituitary surgeons do not differ between endoscopic and microscopic techniques. Regardless of the mode of resection, patients with high preoperative GH levels and Knosp scores are less likely to achieve remission. An immediate postoperative GH level of less than 1.15 ng/mL provides the best immediate predictor of remission, but long-term outcomes are indicated.
目前尚不清楚经蝶窦内镜手术（ETSS）与显微镜下经蝶窦手术（MTS），哪种手术方式对垂体腺瘤更具优势。
本研究旨在通过使用当前公认的肢端肥大症缓解标准，比较经验丰富的垂体外科医生采用 ETSS 和 MTS 手术的结果。
这是一项前瞻性记录结果的回顾性研究。该研究在一家三级转诊中心进行。
患者、干预措施和结果测量：缓解的定义为 IGF-I 水平正常，口服葡萄糖耐量试验时 GH 低于 0.4ng/mL 或随机 GH 低于 1.0ng/mL。计算 Youden 指数以确定使用术后即刻 GH 水平来预测以后的缓解测试结果的最佳截断值。
接受 ETSS（72 例）或 MTS（41 例）治疗的患者术前人口统计学和肿瘤特征无显著差异。总体而言，23 例微腺瘤中有 20 例（87%）和 90 例大腺瘤中有 59 例（66%）术后达到缓解。ETSS 和 MTS 组之间的缓解率和围手术期并发症无显著差异，但 ETSS 组患者报告的鼻窦炎和味觉或嗅觉改变发生率明显更高。多变量分析中预测缓解的术前变量包括 GH 低于 45ng/mL[比值比（OR）6.4，P=0.010）]和 Knosp 评分为 0-2（OR 6.8，P<0.001）。术后住院期间 GH 低于 1.15ng/mL 是预测缓解的最佳指标（OR 7.7，P<0.001；敏感性为 73%，特异性为 85%），该指标通过随访测试定义。
经验丰富的垂体外科医生行经蝶窦手术治疗肢端肥大症的结果，内镜技术与显微镜技术之间无差异。无论切除方式如何，术前 GH 水平高和 Knosp 评分低的患者缓解可能性较小。术后即刻 GH 水平低于 1.15ng/mL 是缓解的最佳即时预测指标，但需要长期随访。
