Ishikawa Takayuki, Takeuchi Kazuhito, Nagatani Tetsuya, Aimi Yuri, Tanemura Eriko, Tambara Masao, Nagata Yuichi, Choo Jungsu, Wakabayashi Toshihiko
Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan; Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan.
Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan.
World Neurosurg. 2019 Feb;122:e1202-e1210. doi: 10.1016/j.wneu.2018.11.017. Epub 2018 Nov 14.
Although reports regarding the relationship between surgical complications and quality of life (QOL) exist, a general consensus regarding this issue is lacking. The aim of this study was to evaluate QOL after endoscopic transsphenoidal approach.
We assessed patients with sellar or parasellar lesions that were removed with endoscopic transsphenoidal approach or extended endoscopic transsphenoidal approach between January 2010 and December 2016. 36-Item Short Form Health Survey and 30-Item General Health Questionnaire QOL scores were obtained preoperatively and 1 month and 6 months postoperatively.
We analyzed 89 patients with nonfunctioning pituitary adenoma (NFPA) and 39 patients with acromegaly. Physical QOL decreased 1 month after surgery but recovered after 6 months in both groups. Mental QOL improved postoperatively compared with preoperatively. Patients with acromegaly had a worse Physical Component Summary (PCS) on 36-Item Short Form Health Survey (48.7, 28.9, and 41.0) at 6 months than patients with NFPA. The low preoperative PCS group did not improve until 6 months postoperatively. Multiple regression analysis revealed the following factors were key to postoperative QOL: age (NFPA PCS 6 months postoperatively; correlation coefficient = -0.489), preoperative Mental Component Summary (MCS) (NFPA MCS 6 months postoperatively, correlation coefficient = 0.573), body mass index (acromegaly PCS 6 months postoperatively; correlation coefficient = -0.376), preoperative PCS (acromegaly PCS 6 months postoperatively; correlation coefficient = 0.905), and preoperative MCS (acromegaly MCS 6 months postoperatively; correlation coefficient = 0.726).
Endoscopic transsphenoidal approach can improve QOL in patients by 6 months postoperatively. In patients with acromegaly with significant QOL impairments preoperatively, surgery sometimes may be unable to normalize QOL.
尽管有关于手术并发症与生活质量（QOL）之间关系的报告，但在这个问题上尚未达成普遍共识。本研究的目的是评估经鼻内镜蝶窦入路术后的生活质量。
我们评估了2010年1月至2016年12月期间采用经鼻内镜蝶窦入路或扩大经鼻内镜蝶窦入路切除鞍区或鞍旁病变的患者。术前以及术后1个月和6个月获取36项简短健康调查问卷和30项一般健康问卷的生活质量评分。
我们分析了89例无功能垂体腺瘤（NFPA）患者和39例肢端肥大症患者。两组患者术后1个月身体生活质量均下降，但6个月后恢复。与术前相比，术后心理生活质量有所改善。肢端肥大症患者在术后6个月时36项简短健康调查问卷的身体成分总结（PCS）得分（48.7、28.9和41.0）比NFPA患者差。术前PCS得分低的组直到术后6个月才有所改善。多元回归分析显示以下因素是术后生活质量的关键因素：年龄（NFPA术后6个月PCS；相关系数=-0.489）、术前心理成分总结（MCS）（NFPA术后6个月MCS，相关系数=0.573）、体重指数（肢端肥大症术后6个月PCS；相关系数=-0.376）、术前PCS（肢端肥大症术后6个月PCS；相关系数=0.905）和术前MCS（肢端肥大症术后6个月MCS；相关系数=0.726）。
经鼻内镜蝶窦入路术后6个月可改善患者的生活质量。对于术前生活质量有显著损害的肢端肥大症患者，手术有时可能无法使生活质量恢复正常。
