Endonasal endoscopic versus microscopic transsphenoidal surgery in pituitary tumors among the young: A comparative study & meta-analysis
Endonasal endoscopic versus microscopic transsphenoidal surgery in pituitary tumors among the young: A comparative study & meta-analysis
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DOI：
10.1016/j.clineuro.2020.106411
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发表时间：
2021-01-01
影响因子：
1.9
通讯作者：
Gupta, Sunil K.
中科院分区：
文献类型：
--
作者：
Dhandapani, Sivashanmugam;Narayanan, Rajasekhar;Gupta, Sunil K.
目的：经蝶入路对年轻人提出了独特的挑战，但文献很少。本研究通过荟萃分析比较了我们中心内窥镜 (EES) 和显微 (MTS) 经蝶手术治疗年轻人垂体瘤的结果。方法：对 20 年内的患者进行了研究，以了解他们的手术方法是否能获得内分泌缓解 (ER)（功能性）或大体/近全切除（无功能）的良好结果，此外还不需要再治疗。根据 PRISMA 指南汇总和分析相关研究。结果：64 名年轻垂体瘤患者中，48 人接受了 MTS（33）或 EES（15）的经蝶手术。其中，21 例、14 例、5 例和 8 例分别患有库欣瘤、生长激素瘤、催乳素瘤和非分泌性肿瘤。平均症状持续时间为 28 个月，其中体重增加 (50%) 和视觉不适 (29%) 最常见。性腺功能减退症（21%）是最常见的内分泌疾病。平均肿瘤体积为 3.8 cm3。在平均 4.4 年的随访中，EES 后的良好结果显着高于 MTS（78.6 % vs. 46.7 %）（比值比 4.18，p = 0.05）。 EES 的较好结果在不同年龄和肿瘤类型的亚组中是一致的，没有显着的亚组差异。需要重新治疗的患者的症状持续时间明显更长（p = 0.05），而 ER 与肿瘤体积没有显着相关性（p = 0.07）。总体而言，随访时分别有 40%、27%、17% 和 8% 的人服用氢化可的松、甲状腺素、性激素和去氨加压素，EES 和 MTS 之间没有显着差异。在文献汇总分析中，EES 的良好结局（74 % vs. 48 %，p = 0.02）和复治率（8% vs. 37 %，p = 0.004）均显着优于 MTS。结论：在年轻垂体瘤患者中，鼻内镜检查的良好结局和复治率更好，且与症状持续时间和肿瘤体积相关。
Purpose: The transsphenoidal approach presents unique challenges in young, with scanty literature. This study compares the outcome of pituitary tumors among young in our center between endoscopic(EES) and microscopic (MTS) transsphenoidal surgery, with a meta-analysis.Methods: Patients within 20 years were studied for their surgical approach to a favorable outcome of endocrine remission (ER) (functioning) or Gross/Near-Total resection (nonfunctioning), besides the need for retreatment. Relevant studies were pooled and analyzed according to PRISMA guidelines.Results: Out of 64 young patients with pituitary tumors, 48 underwent transsphenoidal surgery using MTS(33) or EES(15). Of these, 21, 14, 5, and 8 had Cushing's, somatotropinomas, prolactinomas, and non-secreting tumors, respectively. Mean symptom duration was 28months, with weight gain(50 %) and visual complaints(29 %) most prevalent. Hypogonadism(21 %) was the most frequent endocrinopathy. The mean tumor volume was 3.8 cm3. Over mean follow-up of 4.4years, favorable outcome was significantly higher after EES than MTS(78.6 % vs. 46.7 %)(odds ratio 4.18, p = 0.05). EES's better outcome was homogeneous across subgroups of age and tumor type, with no significant subgroup difference. Symptom duration was significantly higher among those who required retreatment(p = 0.05), while ER had a non-significant association with tumor volume(p = 0.07). Overall, 40 %, 27 %, 17 %, and 8% were on hydrocortisone, thyroxine, sex hormone, and desmopressin, respectively, at followup with no significant difference between EES and MTS. In pooled analysis of literature, both favorable outcome (74 % vs. 48 %,p = 0.02) and retreatment rate(8% vs. 37 %,p = 0.004) were significantly better with EES than MTS.Conclusion: Among young patients with pituitary tumors, the favorable outcome and retreatment rates are better with endonasal endoscopy and associated with symptom duration and tumor volume.