Hong Sang Duk, Nam Do-Hyun, Park JunOh, Kim Hyo Yeol, Chung Seung-Kyu, Dhong Hun-Jong
Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea.
Am J Rhinol Allergy. 2014 Nov-Dec;28(6):517-9. doi: 10.2500/ajra.2014.28.4109.
Olfaction has been shown to have a large impact on patients' lives. Endoscopic pituitary surgery is associated with potentially significant damage to olfactory tissues. The objective of this study was to determine the effect of cauterization on olfactory function when performing endoscopic pituitary surgery with a nasoseptal "rescue" flap.
A retrospective review was performed of prospectively collected data. Olfaction was the primary outcome and was measured using the subjective visual analog scale (VAS; 0-100) and Cross-Cultural Smell Identification Test (CC-SIT) before and 3 months after surgery. Significant olfactory deficit was defined as >20% loss compared with preoperative functions. Patients who underwent an endoscopic transsphenoidal approach with NSRFs for pituitary adenoma from June 2012 to March 2013 were included. Included patients were divided into two groups; group 1 underwent rescue flaps raised by monopolar cautery and group 2 underwent rescue flaps by cold knife.
Forty-nine patients were included in this study. There were 19 patients in group 1 and 30 patients in group 2. There was no significant difference in subjective olfactory change between the two groups (p = 0.386; group 1, 13.68 ± 17.7, versus group 2, 6.83 ± 8.25). However, 5 of 19 patients (26.3%) had significant olfactory loss in group 1 and 1 of 30 (3.3%) in group 2. This difference was statistically significant (p = 0.027). None of the patients showed a significant decrease in CC-SIT score.
Raising the rescue flap by cold knife could reduce the rate of hyposmia compared with using an electrocautery postoperatively.
嗅觉已被证明对患者的生活有很大影响。内镜垂体手术可能会对嗅觉组织造成潜在的重大损害。本研究的目的是确定在使用鼻中隔“挽救”皮瓣进行内镜垂体手术时烧灼对嗅觉功能的影响。
对前瞻性收集的数据进行回顾性分析。嗅觉是主要结局指标，在手术前和术后3个月使用主观视觉模拟量表（VAS；0-100）和跨文化嗅觉识别测试（CC-SIT）进行测量。与术前功能相比，嗅觉显著减退定义为丧失>20%。纳入2012年6月至2013年3月因垂体腺瘤接受内镜经蝶窦入路并使用鼻中隔挽救皮瓣的患者。纳入的患者分为两组；第1组通过单极烧灼掀起挽救皮瓣，第2组通过冷刀掀起挽救皮瓣。
本研究共纳入49例患者。第1组19例，第2组30例。两组间主观嗅觉变化无显著差异（p = 0.386；第1组为13.68±17.7，第2组为6.83±8.25）。然而，第1组19例患者中有5例（26.3%）出现显著嗅觉丧失，第2组30例中有1例（3.3%）。这种差异具有统计学意义（p = 0.027）。所有患者的CC-SIT评分均未出现显著下降。
与术后使用电烧灼相比，使用冷刀掀起挽救皮瓣可降低嗅觉减退的发生率。
