Pan Xinfa, Ma Yuehui, Fang Minwei, Jiang Jiajing, Shen Jie, Zhan Renya
Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Front Neurol. 2020 Oct 20;11:527323. doi: 10.3389/fneur.2020.527323. eCollection 2020.
The endoscopic transsphenoidal pituitary surgery has gained popularity and has shown excellent results with a more comfortable postoperative course. However, the quality of the early postoperative course is not well-established in endoscopic transsphenoidal pituitary surgery. We hypothesized that the quality of the early postoperative course would be improved when an enhanced recovery after surgery (ERAS) protocol and minimally invasive endoscopic transsphenoidal pituitary surgery is implemented. We implemented a perioperative management ERAS protocol for endoscopic transsphenoidal pituitary surgery by an experienced surgeon (Yuehui Ma) in our department from January 2018. From then the endoscopic transsphenoidal pituitary surgery was implemented with a minimally invasive technique, such as bony sella reconstruction and partial nasal packing. We compared the results of 78 endoscopic transsphenoidal pituitary surgery cases during the initiation of the ERAS protocol and minimally invasive technique implementation: 37 cases in the control group and 41 cases in the ERAS group. Outcomes assessed included the effectiveness and security of surgery, postoperative hospital length of stay (LOS), and postoperative status on postoperative day 1 (POD1). Postoperative status on POD1, such as nasal ventilation, out of bed, headache score, and liquid supplement, had significant improvement ( < 0.05). The median postoperative LOS decreased from 8 days in the control group to 3 days in the ERAS group ( < 0.05). The ERAS group had better economic benefit with fewer hospital charges ( < 0.05). There was no difference in the early postoperative diabetes insipidus and 30-day readmission for epistaxis, hyponatremia, or other complications between the two groups. The quality of the early postoperative course was improved when a neurosurgical ERAS protocol and minimally invasive endoscopic transsphenoidal pituitary surgery with partially nasal packing were implemented. Endoscopic transsphenoidal pituitary day surgery could be recommended in some classes of patients though further evaluation in large case studies is warranted.
内镜经蝶窦垂体手术已越来越受欢迎，且术后恢复过程较为舒适，效果良好。然而，内镜经蝶窦垂体手术术后早期恢复过程的质量尚未得到充分确立。我们推测，实施术后加速康复（ERAS）方案和微创内镜经蝶窦垂体手术可改善术后早期恢复过程的质量。自2018年1月起，我们科室经验丰富的外科医生（马跃辉）为内镜经蝶窦垂体手术实施了围手术期管理ERAS方案。从那时起，采用微创技术进行内镜经蝶窦垂体手术，如蝶鞍骨质重建和部分鼻腔填塞。我们比较了ERAS方案启动及微创技术实施期间78例内镜经蝶窦垂体手术病例的结果：对照组37例，ERAS组41例。评估的结果包括手术的有效性和安全性、术后住院时间（LOS）以及术后第1天（POD1）的术后状况。POD1的术后状况，如鼻腔通气、下床活动、头痛评分和液体补充情况，有显著改善（<0.05）。术后中位LOS从对照组的8天降至ERAS组的3天（<0.05）。ERAS组经济效益更好，住院费用更少（<0.05）。两组术后早期尿崩症以及鼻出血、低钠血症或其他并发症的30天再入院率无差异。实施神经外科ERAS方案以及采用部分鼻腔填塞的微创内镜经蝶窦垂体手术可改善术后早期恢复过程的质量。尽管需要在大型病例研究中进行进一步评估，但对于某些类型的患者可推荐内镜经蝶窦垂体日间手术。
