开放手术与内镜颅底手术入路患者生活质量的多机构比较
Multi-Institutional Comparison of Quality of Life Between Open Versus Endoscopic Skull Base Approaches.
作者信息
de Almeida John R, Hueniken Katrina, Xie Michael, Monteiro Eric, Zadeh Gelareh, Kalyvas Aristotelis, Gullane Patrick, Snyderman Carl, Wang Eric, Gardner Paul, Fliss Dan, Ringel Barak, Gil Ziv, Na'ara Shorook, Ooi Eng, Goldstein David, Witterick Ian
机构信息
Department of Otolaryngology Head and Neck Surgery University Health Network/Princess Margaret Cancer Center, University of Toronto Toronto Ontario Canada.
Institute of Health Policy, Management and Evaluation University of Toronto Toronto Ontario Canada.
出版信息
Laryngoscope Investig Otolaryngol. 2025 Jan 21;10(1):e70082. doi: 10.1002/lio2.70082. eCollection 2025 Feb.
OBJECTIVES
The primary objective of this prospective review was to compare quality of life between patients undergoing endoscopic and open skull base approaches.
STUDY TYPE AND DESIGN
Prospective Review.
METHODS
Five centers recruited consecutive patients treated surgically for skull base neoplasms between 2012 to 2018. The Skull Base Inventory (SBI), Anterior Skull Base (ASB), and Sinonasal Outcome Test (SNOT-22) were administered up to 12 months post-operatively. Mean change from baseline scores were compared with univariable and multivariable analyses.
RESULTS
A total of 180 patients were included: 108 (60%) F and 72 (40%) M, of whom 126 (70%) underwent endoscopic and 54 (30%) underwent open approaches. Patients undergoing endoscopic approaches were more likely to have sellar or clival pathology (68 vs. 15%, < 0.001). Those undergoing endoscopic approaches had better disease-specific quality of life at one year using the SBI and ASB (mean change from baseline = 7.2 vs. 0.69, = 0.004; 5.8 vs. -1.1, = 0.002), respectively. On multivariable analysis, endoscopic approach was associated with greater improvement in overall quality of life (mean difference in change scores from baseline = 6.5, = 0.009), as well as endocrine (mean difference = 8.3, = 0.011), neurologic (mean difference = 8.3, = 0.012), visual (mean difference = 7.9; = 0.032), financial (mean difference = 9.7, = 0.03), and spiritual domain scores (mean difference = 4.0, = 0.035). Subgroup analyses of pituitary and non-pituitary histopathologies demonstrated trends towards greater quality of life at 1-year compared to baseline in the endoscopic approach compared to the open group.
CONCLUSIONS
Endoscopic approaches are associated with better quality of life compared to open approaches. However, baseline differences in histopathology between the group limit the direct comparison of the open and endoscopic approaches. Future studies with larger and more homogenous samples are required.
LEVEL OF EVIDENCE
Level IV evidence.
目的
本前瞻性综述的主要目的是比较接受内镜和开放颅底手术的患者的生活质量。
研究类型与设计
前瞻性综述。
方法
五个中心纳入了2012年至2018年间接受颅底肿瘤手术治疗的连续患者。在术后长达12个月时进行颅底量表（SBI）、前颅底量表（ASB）和鼻窦结局测试（SNOT-22）评估。通过单变量和多变量分析比较与基线评分的平均变化。
结果
共纳入180例患者：108例（60%）为女性，72例（40%）为男性，其中126例（70%）接受内镜手术，54例（30%）接受开放手术。接受内镜手术的患者更可能患有鞍区或斜坡病变（68%对15%，<0.001）。使用SBI和ASB评估，接受内镜手术的患者在术后一年的疾病特异性生活质量更好（与基线相比的平均变化分别为7.2对0.69，=0.004；5.8对-1.1，=0.002）。多变量分析显示，内镜手术与总体生活质量的更大改善相关（与基线相比变化评分的平均差异=6.5，=0.009），以及内分泌（平均差异=8.3，=0.011）、神经（平均差异=8.3，=0.012）、视觉（平均差异=7.9；=0.032）、经济（平均差异=9.7，=0.03）和精神领域评分（平均差异=4.0，=0.035）。垂体和非垂体组织病理学的亚组分析表明，与开放手术组相比，内镜手术组在术后1年的生活质量相对于基线有提高的趋势。
结论
与开放手术相比，内镜手术与更好的生活质量相关。然而，两组之间组织病理学的基线差异限制了开放手术和内镜手术的直接比较。需要开展样本量更大且更具同质性的未来研究。
证据等级
四级证据。
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