Endoscopic endonasal transsphenoidal approach: An additional reason in support of surgery in the management of pituitary lesions
Endoscopic endonasal transsphenoidal approach: An additional reason in support of surgery in the management of pituitary lesions
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DOI：
10.1055/s-2008-1058157
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发表时间：
1999-01-01
期刊：
影响因子：
--
通讯作者：
de Divitiis, E
中科院分区：
文献类型：
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作者：
Cappabianca, P;Alfieri, A;de Divitiis, E
对10例经鼻蝶入路与20例传统经鼻蝶入路（TTA）切除垂体腺瘤的疗效进行了比较。在10例接受“单纯内镜检查”的患者中，2例为微腺瘤，1例为鞍内大腺瘤，4例为大腺瘤伴鞍上扩张，2例为大腺瘤伴鞍旁上扩张，1例为残留肿瘤; 5例为肢端肥大症，5例为无功能腺瘤（NFA）。在接受TTA的患者中，4例有微腺瘤，2例有鞍内大腺瘤，6例有鞍上扩张的大腺瘤，4例有鞍旁扩张的大腺瘤，4例有残留肿瘤; 9例患者有肢端肥大症，1例高泌乳素血症，1例库欣病，9例NFA。在肉眼评价时，9例患者在内窥镜检查后肿瘤完全切除（100%），14例患者在TFA后肿瘤完全切除。术后6个月，23例患者中有21例（91.3%）的磁共振成像（MRI）证实肿瘤全切除。所有14例肢端肥大症患者术后6个月循环生长激素（GH）和胰岛素样生长因子-I（IGF-I）均显著降低：5例患者中有4例在内镜手术后血浆IGF-I水平恢复正常，9例患者中有4例在TTA后恢复正常。术前，30例患者中有14例存在垂体激素缺乏症：4例患者垂体功能改善，其余10例患者保持不变。4例患者术前存在视野缺损，均得到改善。10例接受内镜下垂体瘤切除术的患者的早期手术结果至少与标准TTA相当，术后病程良好。与TTA相比，内窥镜检查后的术后住院时间显著缩短（3.1 +/- 0.4 vs. 6.2 +/- 0.3天，p < 0.001）。
The outcome of endoscopic endonasal transsphenoidal surgery in 10 patients with pituitary adenomas was compared with that of traditional transnasal transsphenoidal approach (TTA) in 20 subjects. Among the 10 individuals Subjected to "pure endoscopy,'' 2 had a microadenoma, 1 an intrasellar macroadenoma 4 had a macroadenoma with suprasellar lar expansion, 2 had a macroadenoma with supra-parasellar expansion, and 1 a residual tumor; 5 had acromegaly and 5 had a nonfunctioning adenoma (NFA). Among the patients subjected to TTA, 4 had a microadenoma, 2 had an intrasellar macroadenoma, 6 had a macroadenoma with suprasellar expansion, 4 had a macroadenoma with supra-parasellar expansion, and 4 had a residual tumor; 9 patients had acromegaly, 1 hyperprolactinemia, 1 Cushing's disease, and 9 a NFA. At the macroscopic evaluation, tumor removal was total (100%) after endoscopy in 9 patients and after TFA in 14 patients. Six months after surgery magnetic resonance imaging (MRI) confirmed the total tumor removal in 21 of 23 patients (91.3%). Circulating growth hormone (GH) and insulin-like growth factor-I (IGF-I) significantly decreased 6 months after surgery in all 14 acromegalic patients: normalization of plasma IGF-I levels was obtained in 4 of 5 patients after the endoscopic procedure and in 4 of 9 patients after TTA. Before surgery, pituitary hormone deficiency was, present in 14 out of 30 patients: pituitary function improved in 4 patients, remaining unchanged in the other 10 patients. Visual field defects were present before surgery in 4 patients, and improved in all. Early surgical results in the group of 10 patients who underwent endoscopic pituitary tumor removal were at least equivalent: to those of standard TTA, with excellent postoperative course. Postsurgical hospital stay was significantly shorter (3.1 +/- 0.4 vs. 6.2 +/- 0.3 days, p < 0.001) after endoscopy as compared to TTA.