经鼻腔蝶窦入路切除垂体大腺瘤的额外假包膜：技术要点及内分泌功能评估。
Extra-pseudocapsular Transnasal Transsphenoidal Resection of Pituitary Macroadenoma: Technique Note and Evaluation of Endocrine Function.
机构信息
Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Department of Neurosurgery, University Hospital Erlangen, Schwabachanlage 6, Erlangen, 91054, Germany.
出版信息
Curr Med Sci. 2022 Dec;42(6):1148-1156. doi: 10.1007/s11596-022-2674-5. Epub 2022 Dec 21.
OBJECTIVE
In this study, we investigated the surgical technique and endocrine assessment of pituitary function of patients with macroadenoma treated by extra-pseudocapsular transnasal transsphenoidal surgery (ETTS).
METHODS
Clinical data of 144 patients with pituitary macroadenomas in the same surgical group at the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were retrospectively analyzed from January 2019 to June 2021. Based on the results of the endocrinological evaluation and MRI examinations before and after surgery, the fluctuation of pituitary function and the extent of resection were analyzed. Multiple Logistic regression analysis was used to determine the predictors affecting postoperative tumor residual.
RESULTS
Among the 144 patients with pituitary macroadenomas, 72 (50.0%) were female and 72 (50.0%) were male, the median age was 50 years, 26 (18.1%) had invasiveness grade 0, 46 (31.9%) had grade I, 57 (39.6%) had grade II, and 15 (10.4%) had grade III according to Lu's classification method. Based on observation during surgery, 37 cases (25.7%) had no pseudocapsule, 54 cases (37.5%) had incomplete pseudocapsule, and 53 cases (36.8%) had intact pseudocapsule. In addition, 91 (63.2%) patients had total resection, 39 (27.1%) had subtotal resection, and 14 (9.7%) had partial resection. As for anterior pituitary function, 13 of 19 hypothyroid patients had recovery after surgery, with a remission rate of 68.4%. Eighteen of the 26 decreased cortisol patients got back to normal, with a remission rate of 69.2%. A total of 27 of 51 patients with hypogonadism improved, with a remission rate of 52.9%. Univariate and multivariate analyses indicated that gender, tumor size, and invasiveness were predictors of postoperative residual in patients (P<0.05).
CONCLUSION
The results showed that ETTS is an effective treatment modality for restoring the function of pituitary gland of the patients with macroadenomas. Tumor size and invasiveness are predictors of the extent of surgical resection and postoperative residual of macroadenomas.
目的
本研究旨在探讨经蝶窦入路切除垂体大腺瘤（extra-pseudocapsular transnasal transsphenoidal surgery，ETTS）患者的手术技术和垂体功能的内分泌评估。
方法
回顾性分析 2019 年 1 月至 2021 年 6 月华中科技大学同济医学院附属同济医院神经外科同一手术组 144 例垂体大腺瘤患者的临床资料。根据手术前后内分泌评估和 MRI 检查结果，分析垂体功能波动和肿瘤切除程度。采用多因素 Logistic 回归分析确定影响术后肿瘤残留的预测因素。
结果
144 例垂体大腺瘤患者中，男 72 例（50.0%），女 72 例（50.0%）；年龄中位数为 50 岁；Lu 分级法 0 级 26 例（18.1%），Ⅰ级 46 例（31.9%），Ⅱ级 57 例（39.6%），Ⅲ级 15 例（10.4%）。根据术中观察，无假包膜 37 例（25.7%），假包膜不完整 54 例（37.5%），假包膜完整 53 例（36.8%）。此外，91 例（63.2%）患者行肿瘤全切除，39 例（27.1%）行次全切除，14 例（9.7%）行部分切除。术前甲状腺功能减退 19 例，术后恢复 13 例，缓解率为 68.4%；皮质醇减少 26 例，术后恢复正常 18 例，缓解率为 69.2%；性腺功能减退 51 例，改善 27 例，缓解率为 52.9%。单因素和多因素分析表明，性别、肿瘤大小和侵袭性是影响术后残留的预测因素（P<0.05）。
结论
研究表明，ETTS 是一种有效治疗垂体大腺瘤的方法，可恢复患者的垂体功能。肿瘤大小和侵袭性是预测垂体大腺瘤手术切除程度和术后残留的因素。
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