Huang Yuanzhi, Zheng Tao, Liu Yang, Fang Rongjin
Department of Neurosurgery, Xi'an International Medical Center Hospital Xi'an 710100, Shaanxi, China.
Department of Neurosurgery, Ankang Hospital of Traditional Chinese Medicine Ankang 725000, Shaanxi, China.
Am J Transl Res. 2023 Jul 15;15(7):4746-4754. eCollection 2023.
To compare microscopic transsphenoidal surgery (MTS) and neuroendoscopic transsphenoidal surgery (NTS) in pituitary adenoma (PA) resection and analyze the risk factors of postoperative cerebrospinal fluid leakage (CFL).
The clinical data of 127 patients with PA treated in Xi'an International Medical Center Hospital from January 2019 to January 2021 were analyzed retrospectively. Among them, 54 patients treated by MTS for PA resection were assigned to the control group, while the rest of the 73 patients treated by NTS for PA resection were assigned to the study group. The total tumor resection rate, decrease of hormone levels after operation, alleviation of primary symptoms and complications were compared between the two groups. Logistics regression analysis was conducted to analyze the risk factors of CFL.
The control group experienced a shorter operation time than the study group (P<0.001). The resection rates of the control and study groups were comparable, but the study group showed a lower incidence of postoperative complications than the control group (P = 0.004). In addition, the study group showed better alleviation of primary symptoms than the control group (P = 0.013). After surgery, the two groups presented decreased levels of prolactin and growth hormone (P<0.001), and also showed decreased average adrenocorticotropic hormone (P<0.001). Moreover, the two groups were not significantly different in the levels of prolactin, growth hormone and adrenocorticotropic hormone after surgery (P>0.05). According to multivariate logistics regression analysis, body mass index (BMI) (P = 0.003, OR = 8.791, 95% CI: 2.050-37.693), intraoperative CFL (P = 0.002, OR = 21.614, 95% CI: 0.305-153.162) and therapeutic regimen (P = 0.011, OR = 7.060, 95% CI: 1.554-32.076) were independent risk factors for postoperative CFL.
Compared with MTS, endoscopic transsphenoidal surgery requires a notably longer time, but it can strongly improve the total resection rate of patients and reduce the incidence of postoperative complications. Endoscopic surgery is a protective factor of postoperative CFL.
比较显微镜下经蝶窦手术（MTS）与神经内镜下经蝶窦手术（NTS）在垂体腺瘤（PA）切除术中的效果，并分析术后脑脊液漏（CFL）的危险因素。
回顾性分析2019年1月至2021年1月在西安国际医学中心医院接受治疗的127例PA患者的临床资料。其中，54例行MTS切除PA的患者被分配到对照组，其余73例行NTS切除PA的患者被分配到研究组。比较两组的肿瘤全切除率、术后激素水平下降情况、主要症状缓解情况及并发症发生情况。进行Logistic回归分析以分析CFL的危险因素。
对照组的手术时间比研究组短（P<0.001）。对照组和研究组的切除率相当，但研究组术后并发症的发生率低于对照组（P = 0.004）。此外，研究组主要症状的缓解情况优于对照组（P = 0.013）。术后，两组患者的催乳素和生长激素水平均下降（P<0.001），促肾上腺皮质激素平均水平也下降（P<0.001）。而且，两组术后催乳素、生长激素和促肾上腺皮质激素水平差异无统计学意义（P>0.05）。根据多因素Logistic回归分析，体重指数（BMI）（P = 0.003，OR = 8.791，95%CI：2.050 - 37.693）、术中脑脊液漏（P = 0.002，OR = 21.614，95%CI：0.305 - 153.162）和治疗方案（P = 0.011，OR = 7.060，95%CI：1.554 - 32.076）是术后脑脊液漏的独立危险因素。
与MTS相比，神经内镜下经蝶窦手术所需时间明显更长，但能显著提高患者的全切除率并降低术后并发症的发生率。内镜手术是术后脑脊液漏的保护因素。
