PDF(Pubmed)
Abstract：
OBJECTIVE: The success and outcomes of repeat endoscopic transsphenoidal surgery (ETS) for residual or recurrent Cushing\'s disease (CD) are underreported in the literature. This study aims to address this gap by assessing the safety, feasibility, and efficacy of repeat ETS in these patients.
METHODS: A retrospective analysis was conducted on 56 patients who underwent a total of 65 repeat ETS performed by a single neurosurgeon between January 2006 and December 2020. Data including demographic, clinical, laboratory, radiological, and operative details were collected from electronic medical records. Logistic regression was utilized to identify potential predictors associated with sustained remission.
RESULTS: Among the cases, 40 (61.5%) had previously undergone microscopic surgery, while 25 (38.5%) had prior endoscopic procedures. Remission was achieved in 47 (83.9%) patients after the first repeat ETS, with an additional 9 (16.1%) achieving remission after the second repeat procedure. During an average follow-up period of 97.25 months, the recurrence rate post repeat surgery was 6.38%. Sustained remission was achieved in 48 patients (85.7%), with 44 after the first repeat ETS and 4 following the second repeat ETS. Complications included transient diabetes insipidus (DI) in 5 (7.6%) patients, permanent (DI) in 2 (3%) patients, and one case (1.5%) of panhypopituitarism. Three patients (4.6%) experienced rhinorrhea necessitating reoperation. A serum cortisol level > 5 µg/dL on postoperative day 1 was associated with a reduced likelihood of sustained remission.
CONCLUSIONS: Repeat ETS is a safe and effective treatment option for residual or recurrent CD with satisfactory remission rates and low rates of complications.
METHODS: A retrospective analysis was conducted on 56 patients who underwent a total of 65 repeat ETS performed by a single neurosurgeon between January 2006 and December 2020. Data including demographic, clinical, laboratory, radiological, and operative details were collected from electronic medical records. Logistic regression was utilized to identify potential predictors associated with sustained remission.
RESULTS: Among the cases, 40 (61.5%) had previously undergone microscopic surgery, while 25 (38.5%) had prior endoscopic procedures. Remission was achieved in 47 (83.9%) patients after the first repeat ETS, with an additional 9 (16.1%) achieving remission after the second repeat procedure. During an average follow-up period of 97.25 months, the recurrence rate post repeat surgery was 6.38%. Sustained remission was achieved in 48 patients (85.7%), with 44 after the first repeat ETS and 4 following the second repeat ETS. Complications included transient diabetes insipidus (DI) in 5 (7.6%) patients, permanent (DI) in 2 (3%) patients, and one case (1.5%) of panhypopituitarism. Three patients (4.6%) experienced rhinorrhea necessitating reoperation. A serum cortisol level > 5 µg/dL on postoperative day 1 was associated with a reduced likelihood of sustained remission.
CONCLUSIONS: Repeat ETS is a safe and effective treatment option for residual or recurrent CD with satisfactory remission rates and low rates of complications.
摘要：
目的：重复内镜经蝶窦手术（ETS）治疗残留或复发库欣病（CD）的成功和结果在文献中报道不足。这项研究旨在通过评估安全性来解决这一差距，可行性,以及这些患者重复ETS的疗效。
方法：对56例患者进行了回顾性分析，这些患者在2006年1月至2020年12月期间由一名神经外科医生进行了65次重复ETS。数据包括人口统计，临床,实验室,放射学,手术细节从电子病历中收集。Logistic回归用于确定与持续缓解相关的潜在预测因素。
结果：在病例中，40人（61.5%）曾接受过显微手术，而25例(38.5%)曾接受过内窥镜检查。在第一次重复ETS后，47例(83.9%)患者实现了缓解，在第二次重复手术后，又有9例（16.1%）获得缓解。平均随访时间为97.25个月,再次手术后复发率为6.38%.48例患者（85.7%）实现了持续缓解，44在第一次重复ETS之后，4在第二次重复ETS之后。并发症包括5例（7.6％）患者的短暂性尿崩症（DI），2（3％）患者的永久性（DI），1例(1.5%)全垂体功能减退。三名患者（4.6％）经历了鼻漏，需要再次手术。术后第1天血清皮质醇水平>5µg/dL与持续缓解的可能性降低相关。
结论：重复ETS治疗残留或复发CD是一种安全有效的治疗选择，缓解率令人满意，并发症发生率低。
方法：对56例患者进行了回顾性分析，这些患者在2006年1月至2020年12月期间由一名神经外科医生进行了65次重复ETS。数据包括人口统计，临床,实验室,放射学,手术细节从电子病历中收集。Logistic回归用于确定与持续缓解相关的潜在预测因素。
结果：在病例中，40人（61.5%）曾接受过显微手术，而25例(38.5%)曾接受过内窥镜检查。在第一次重复ETS后，47例(83.9%)患者实现了缓解，在第二次重复手术后，又有9例（16.1%）获得缓解。平均随访时间为97.25个月,再次手术后复发率为6.38%.48例患者（85.7%）实现了持续缓解，44在第一次重复ETS之后，4在第二次重复ETS之后。并发症包括5例（7.6％）患者的短暂性尿崩症（DI），2（3％）患者的永久性（DI），1例(1.5%)全垂体功能减退。三名患者（4.6％）经历了鼻漏，需要再次手术。术后第1天血清皮质醇水平>5µg/dL与持续缓解的可能性降低相关。
结论：重复ETS治疗残留或复发CD是一种安全有效的治疗选择，缓解率令人满意，并发症发生率低。
