背景:内镜经鼻蝶入路手术的进展导致垂体腺瘤切除术后的术后结局改善,包括缩短逗留时间,并发症和再入院率,不影响安全性和满意度。
方法:我们的团队于2021年1月实施了一项围手术期协议,经蝶窦垂体手术.这项研究比较了2016年至2022年279例患者的术前特征和术后结果(128例方案前和151例方案后)。我们的方案包括跨学科的术前评估,统一通信,术后糖皮质激素替代的皮质醇阈值,和液体限制以防止迟发性低钠血症。
结果:中位年龄为54±17岁,女性占50.8%。有229(82.1%)大腺瘤(>1cm)和50(17.9%)微腺瘤/囊肿(<1cm)。平均直径为18(横向),18(颅尾),16(前后)毫米。肿瘤类型包括125(44.8%)促性腺激素,46(16.4%)肾上腺皮质激素,40(14.3%)催乳,26个(9.3%)Rathke囊肿,19人(6.8%)生长营养,13(4.6%)非诊断性,3(1%)生长激素-乳糖,3(1%)乳房生长素,2(0.71%)空单元格,和2个(0.7%)甲状腺腺瘤。协议后,74.2%的患者在POD1上出院,而方案前为46.1%(p<0.0001)。短暂性精氨酸加压素缺乏症(AVD)从10.4%(方案前)下降到方案后的4.6%(p=0.101)。低钠血症发生在方案前13.3%和方案后4.6%。急诊科的访问量从9.4%下降到3.9%,再入院率由7.8%下降至2.6%。持续性AVD影响了2.3%的方案前患者和1.3%的方案后患者。CSF泄漏发生在方案前8.5%和方案后7.3%。
结论:实施跨学科,经蝶窦内镜下垂体手术的围手术方案可缩短住院时间,同时最大限度地减少再入院和手术相关并发症.
BACKGROUND: Advances in endoscopic endonasal transsphenoidal surgery have led to improved postoperative outcomes after pituitary adenoma resection, including reduced length of stay, complications and readmission rates, without compromising safety and satisfaction.
METHODS: Our team implemented a perioperative protocol in January 2021 for patients undergoing endoscopic, transsphenoidal pituitary surgery. This study compares preoperative characteristics and postoperative outcomes in 279 patients between 2016 and 2022 (128 preprotocol and 151 postprotocol). Our protocol includes interdisciplinary preoperative evaluations, unified communication, cortisol thresholds for postoperative glucocorticoid replacement, and fluid restriction to prevent delayed hyponatremia.
RESULTS: Median age was 54 ± 17 years with 50.8% female patients. There were 229 (82.1%) macroadenomas (>1 cm) and 50 (17.9%) microadenomas/cysts (<1 cm). Mean diameter was 18 (transverse), 18 (craniocaudal), 16 (anteroposterior) mm. Tumor types included 125 (44.8%) gonadotroph, 46 (16.4%) adrenocorticotroph, 40 (14.3%) lactotroph, 26 (9.3%) Rathke cysts, 19 (6.8%) somatotroph, 13 (4.6%) nondiagnostic, 3 (1%) somatotroph-lactotroph, 3 (1%) mammosomatotroph, 2 (0.71%) null cell, and 2 (0.7%) thyrotroph adenomas. Postprotocol, 74.2% of patients were discharged on postoperative day 1 compared with 46.1% preprotocol (P < 0.0001). Transient arginine vasopressin deficiency decreased from 10.4% (preprotocol) to 4.6% postprotocol (P = 0.101). Hyponatremia occurred in 13.3% pre-protocol and 4.6% postprotocol. Emergency department visits dropped from 9.4% to 3.9%, and readmissions decreased from 7.8% to 2.6%. Persistent arginine vasopressin deficiency affected 2.3% preprotocol and 1.3% postprotocol patients. Cerebrospinal fluid leaks occurred in 8.5% preprotocol and 7.3% postprotocol.
CONCLUSIONS: Implementing an interdisciplinary, perioperative protocol for transsphenoidal endoscopic pituitary surgery improves length of stay while minimizing readmissions and surgery-related complications.