Tomáš Česák, Department of Neurosurgery, University Hospital Hradec Kralove, Sokolská 581, 500 05 Hradec Králové, Czech Republic,
Croat Med J. 2020 Oct 31;61(5):410-421. doi: 10.3325/cmj.2020.61.410.
To compare microsurgical technique (mTSS) and endoscopic technique (eTSS) in the treatment of non-functioning pituitary adenomas (NFPAs).
We retrospectively evaluated the charts of 50 patients who underwent either mTSS or eTSS for NFPA in the Department of Neurosurgery, University Hospital Hradec Kralove from 2013 to 2019. We enrolled all patients who were not treated by postoperative adjuvant radiotherapy and who underwent at least two regular postoperative magnetic resonance imaging (MRI) tests. We compared the groups in terms of the extent of resection, surgery duration, blood loss, complication rate, overall clinical effect on the endocrinological and ophthalmological deficit, and postoperative growth pattern of the residual tumor mass.
The mTSS group had significantly shorter surgical time (75 min vs 127 min, P<0.001) and lower perioperative blood loss (156 mL vs 256 mL, P=0.027). The groups did not significantly differ in the extent of resection, overall clinical or hormonal effect, and the complication rate. The extent of resection did not correlate with tumor consistency, while the tumor growth rate did not correlate with age or Ki-67 expression.
There was no major difference between the approaches in surgery radicality or safeness. However, eTSS remains the method of choice due to its potentially higher postoperative preservation of hormonal functions.
比较显微镜外科技术（mTSS）和内镜外科技术（eTSS）在治疗无功能性垂体腺瘤（NFPAs）中的作用。
我们回顾性评估了 2013 年至 2019 年期间在赫拉德茨克拉洛韦大学医院神经外科接受 mTSS 或 eTSS 治疗 NFPA 的 50 例患者的病历。我们纳入了所有未接受术后辅助放疗且至少进行了 2 次常规术后磁共振成像（MRI）检查的患者。我们比较了两组在肿瘤切除程度、手术时间、失血量、并发症发生率、内分泌和眼科缺陷的总体临床疗效以及术后残余肿瘤生长模式方面的差异。
mTSS 组的手术时间明显更短（75 分钟 vs 127 分钟，P<0.001），围手术期失血量更少（156 毫升 vs 256 毫升，P=0.027）。两组在肿瘤切除程度、总体临床疗效或激素疗效以及并发症发生率方面均无显著差异。肿瘤切除程度与肿瘤硬度无相关性，而肿瘤生长速度与年龄或 Ki-67 表达无关。
两种方法在手术的根治性或安全性方面没有明显差异。然而，由于 eTSS 术后可能更高地保留了激素功能，因此仍是首选方法。
