Endonasal transsphenoidal approach for pituitary adenomas and other sellar lesions: an assessment of efficacy, safety, and patient impressions
Endonasal transsphenoidal approach for pituitary adenomas and other sellar lesions: an assessment of efficacy, safety, and patient impressions
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DOI：
10.3171/jns.2003.98.2.0350
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发表时间：
2003-02-01
影响因子：
4.1
通讯作者：
Swerdloff, R
中科院分区：
文献类型：
--
作者：
Zada, G;Kelly, DF;Swerdloff, R
Object.手术显微镜辅助下直接经鼻入路切除垂体瘤与传统的唇下入路相比具有潜在的优势，可以最大限度地减少术后神经系统并发症，同时保持高度的有效性和安全性。为了评估该手术的有效性，记录了肿瘤缓解率和手术并发症，并使用记录器记录了患者的术后投诉。连续100例患者接受了109例经鼻肿瘤切除术。中位随访期为16个月术后3-45个月，内分泌无活性大腺瘤40例，非侵袭性大腺瘤95%，侵袭性大腺瘤40%;在20例泌乳素瘤患者中，75%的泌乳素瘤初始泌乳素（PRL）水平低于200 ng/ml，15例库欣病患者中，微腺瘤73%，大腺瘤25%;在10名肢端肥大症患者中，75%为微腺瘤，50%为大腺瘤;在5名鼠样裂囊肿患者中，80%;在5名颅咽管瘤患者中，40%。有7例严重手术并发症，无手术死亡。在完成问卷调查的78名患者中（应答率89%），最常见的投诉涉及鼻腔填塞（39%）、填塞物移除（36%）和口呼吸（35%）。术后3个月或更长时间，患者对鼻窦问题的量化如下：面部疼痛，83%无问题，4%严重困难;鼻塞，74%无问题，3%严重困难;鼻气流减少，77%无问题，4%严重困难;嗅觉下降，73%无问题，4%严重困难;对于上唇麻木，87%无问题，1%严重困难。14例曾行唇下手术的患者中有12例（86%）在疼痛和恢复容易性方面首选鼻内入路。直接经鼻入路切除垂体瘤的疗效和并发症发生率与唇下入路相当。患者通常从这种微创手术中迅速恢复，并且没有或只有极轻微的鼻窦不适。对于需要重复手术的患者，鼻内途径似乎比唇下途径疼痛更轻，更容易恢复。考虑到所需的鼻粘膜剥离最少，以及与鼻腔填塞相关的频繁患者投诉，该手术不再使用填塞。
Object. The direct endonasal approach performed with the aid of an operating microscope for removal of pituitary tumors has the potential advantage over the traditional sublabial route of minimizing postoperative rhinological complications, yet maintaining a high degree of efficacy and safety. To assess the effectiveness of this procedure, tumor remission rates and surgical complications were documented, and patients' postoperative complaints were recorded using a questionnaire.Methods. One hundred consecutive patients underwent 109 endonasal operations for tumor removal. At a median follow-up period of 16 months (range 3-45 months), surgical remission rates were as follows: in 40 patients with endocrin-einactive macroadenomas, 95% for noninvasive and 40% for invasive tumors; in the 20 patients with prolactinomas, 75% for prolactinomas with an initial prolactin (PRL) level lower than 200 ng/ml, 33% for those with a PRL level between 200 and 600 ng/ml, and 0% for those with a PRL level higher than 1400 ng/ml; in the 15 patients with Cushing disease, 73% for microadenomas and 25% for macroadenomas; in the 10 patients with acromegaly, 75% for microadenomas and 50% for macroadenomas; in the five patients with Ratlike cleft cysts, 80%; and in the five patients with craniopharyngiomas, 40%. There were seven major surgical complications and no operative deaths. Among the 78 patients who completed questionnaires (response rate 89%), the most common complaints concerned nasal packing (39%), removal of packing (36%), and mouth breathing (35%). At 3 months or longer after surgery, patients quantified sinonasal problems as follows: for facial pain, no problem in 83% and severe difficulty in 4%; for nasal congestion, no problem in 74%, and severe difficulty in 3%; for decreased nasal airflow, no problem in 77% and severe difficulty in 4%; for decreased sense of smell, no problem in 73% and severe difficulty in 4%; and for upper-lip numbness, no problem in 87% and severe difficulty in 1%. Twelve (86%) of 14 patients who had undergone sublabial surgery previously preferred the endonasal approach in terms of pain and ease of recovery.Conclusions. The direct endonasal route for pituitary tumor removal has efficacy and complication rates comparable to those of the sublabial route. Patients generally recover rapidly from this minimally invasive procedure and have no or minimal sinonasal complaints. For patients requiring a repeated operation, the endonasal route appears to be less painful and easier to recover from than the sublabial route. Given the minimal nasal mucosal dissection required and the frequent patient complaints related to nasal packing, use of packing is no longer used for this procedure.