Chaaban Mohamad R, Chaudhry Ajaz L, Riley Kristen O, Woodworth Bradford A
Division of Otolaryngology, Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.
Am J Rhinol Allergy. 2015 Sep-Oct;29(5):365-8. doi: 10.2500/ajra.2015.29.4206.
Transnasal endoscopic pituitary surgery has proven to be a safe and effective method for removing pituitary tumors. Direct and angled endoscopy at the site of dissection provides excellent visualization without external incisions. However, olfactory loss has been documented after surgical approaches to the pituitary and is accompanied by a significant detriment to quality of life.
A prospective cohort study.
Subjects 19 years and older who were undergoing transnasal endoscopic pituitary surgery were recruited for this study. The University of Pennsylvania Smell Identification Test (UPSIT) was administered preoperatively and then at 3-4 months. Data regarding demographics, reconstructive technique, and complications were recorded. The patients had skull-base reconstruction with a Medpore implant or a vascularized nasoseptal flap.
A total of 33 subjects were recruited, with 18 completing the study. The mean (SEM) age was 58.2 ± 2.4 years, with 12 females and 6 males. The majority of patients (89%) had nonfunctioning macroadenomas, and six individuals had reconstruction by using a vascularized nasoseptal flap. Matched mean (SEM) preoperative and postoperative UPSIT scores for this cohort were not significantly different (31.3 ± 0.4 versus 30.5 ± 0.5, respectively; p = 0.54). In addition, there was no significant difference between the mean preoperative and postoperative UPSIT scores of the patients who had nasoseptal flaps (29.4 ± 1.1 vs. 28.6 ± 1.3 respectively; p = 0.87).
In the current study, pre- and postoperative UPSIT scores were not significantly different in patients who underwent endoscopic transnasal pituitary surgery. The use of a nasoseptal flap also did not adversely affect postoperative UPSIT scores.
经鼻内镜垂体手术已被证明是一种安全有效的垂体肿瘤切除方法。在手术解剖部位使用直镜和角镜可提供极佳的视野，且无需外部切口。然而，垂体手术入路后嗅觉丧失已有记录，这对生活质量有显著损害。
一项前瞻性队列研究。
招募19岁及以上接受经鼻内镜垂体手术的受试者参与本研究。术前及术后3 - 4个月进行宾夕法尼亚大学嗅觉识别测试（UPSIT）。记录有关人口统计学、重建技术和并发症的数据。患者采用Medpore植入物或带血管蒂鼻中隔瓣进行颅底重建。
共招募33名受试者，18名完成研究。平均（标准误）年龄为58.2±2.4岁，其中女性12名，男性6名。大多数患者（89%）患有无功能性大腺瘤，6名患者采用带血管蒂鼻中隔瓣进行重建。该队列术前和术后UPSIT评分的匹配均值（标准误）无显著差异（分别为31.3±0.4和30.5±0.5；p = 0.54）。此外，采用鼻中隔瓣的患者术前和术后UPSIT评分均值之间也无显著差异（分别为29.4±1.1和vs. 28.6±1.3；p = 0.87）。
在本研究中，接受内镜经鼻垂体手术的患者术前和术后UPSIT评分无显著差异。使用鼻中隔瓣也未对术后UPSIT评分产生不利影响。
