بررسي تأثير روش هاي مختلف جراحي آندوسكوپيك و ميكروسكوپيك در سرانجام آدنوم هيپوفيز عمل شده در بيمارستان سينا - طي سال هاي 1386 - 1391

Outcome Analysis of Microscopic versus Endoscopic Pituitary Surgery for Resection of Pituitary Adenomas

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺑﺎ ﻭﺭﻭﺩ ﺁﻧﺪﻭﺳﮑﻮﭖ ﺑﻪ ﺣﻴﻄﻪ ﺍﻋﻤﺎﻝ ﺟﺮﺍﺣﻲ ﻣﻐﺰ ﻭ ﺍﻋﺼﺎﺏ ﺍﺯ ﺩﻫﻪ 80 ﻣﻴﻼﺩﻱ، ﺗﺤﻮﻟﻲ ﻧﻮﻳﻦ ﺩﺭ ﺭﻭﺵﻫﺎﻱ ﺟﺮﺍﺣﻲ ﺗﻮﻣﻮﺭﻫﺎﻱ ﻫﻴﭙﻮﻓﻴﺰ ﺍﻳﺠﺎﺩ ﺷ ﺪﻩ ﺍﺳﺖ ﻭ ﺩﺭ ﺣﺎﻝ ﺣﺎﺿﺮ ﺭﻭﺵ ﺁﻧﺪﻭﺳﮑﻮﭘﻴﮏ ﺗﺮﺍﻧﺲ ﺍﺳﻔﻨﻮﺋﻴﺪ ﺩﺭ ﮐﻨﺎﺭ ﺭﻭﺵﻫﺎﻱ ﻗﺪﻳﻤﻲﺗﺮ ﻣﺎﻧﻨﺪ ﻣﻴﮑﺮﻭﺳﮑﻮﭘﻴﮏ ﺗﺮﺍﻧﺲ ﺳﭙﺘﺎﻝ، ﺑﺎ ﻧﺘﺎﻳﺞ ﻗﺎﺑﻞ ﻣﻘﺎﻳﺴﻪ ﺩﺭ ﺣﺎﻝ ﺍ ﻧﺠﺎﻡ ﺍﺳﺖ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺗﻤﺎﻡ ﺑﻴﻤﺎﺭﺍﻧﻲ ﻣﺒﺘﻼ ﺑﻪ ﺁﺩﻧﻮﻡ ﻫﻴﭙﻮﻓﻴﺰ ﮐﻪ ﺩﺭ ﻃﻲ ﺳﺎﻝﻫﺎﻱ 86 ﺗﺎ ﻧﻴﻤﻪ ﺍﻭﻝ ﺳﺎﻝ 91 ﺑﺎ ﻳﮑﻲ ﺍﺯ ﺩﻭ ﺗﮑﻨﻴﮏ ﺁﻧﺪﻭﺳﮑﻮﭘﻴﮏ ﻭ ﻳﺎ ﻣﻴﮑﺮﻭﺳﮑﻮﭘﻴﮏ ﺗ ﺤﺖ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺑﻮﺩﻧﺪ، ﺑﻪ ﻃﻮﺭ ﻣﻨﻈﻢ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺗﺼﻮﻳﺮﺑﺮﺩﺍﺭﻱ ﺍﻡ ﺁﺭ ﺁﻱ، ﺍﺭﺯﻳﺎﺑﻲ ﭘﺮﻭﻓﺎﻳﻞ ﻫﻮﺭﻣﻮﻧﻲ ﻫﻴﭙﻮﻓﻴﺰ ﻭ ﺍﺭﺯﻳﺎﺑﻲﻫﺎﻱ ﺑﻴﻨﺎﻳﻲ ﺳﻨﺠﻲ ﺗﺤﺖ ﭘﻴ ﮕﻴﺮﻱ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ. ﻣﻴﺰﺍﻥ ﻋﻮﺩ، ﻣﻴﺰﺍﻥ ﺑﻬﺒﻮﺩ ﺑﻴﻨﺎﻳﻲ، ﻣﻴﺰﺍﻥ ﻧﺮﻣﺎﻝ ﺷﺪﻥ ﺳﻄﺢ ﻫﻮﺭﻣﻮﻥﻫﺎ ﻭ ﻋﻮﺍﺭﺽ ﮐﻮﺗﺎﻩ ﻣﺪﺕ ﻭ ﻃﻮﻻﻧﻲ ﻣﺪﺕ ﺩﺭ ﻫﺮ ﺩﻭ ﮔﺮﻭﻩ ﺑﺎ ﻳﮑﺪﻳﮕﺮ ﻣﻘﺎﻳﺴﻪ ﺷﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺍﺯ 41 ﺑﻴﻤﺎﺭ ﻣﻮﺭﺩ ﻣﻄﺎﻟﻌﻪ، 32 ﻣﻮﺭﺩ ﺑﺎ ﺗﮑﻨﻴﮏ ﺁﻧﺪﻭﺳﮑﻮﭘﻴﮏ ﻭ 9 ﻣﻮﺭﺩ ﺑﺎ ﺗﮑﻨﻴﮏ ﻣﻴﮑﺮﻭﺳﮑﻮﭘﻴﮏ ﺗﺤﺖ ﻋﻤﻞ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺑﻮﺩﻧﺪ. ﺷﺎﻳﻌﺘﺮﻳﻦ ﺗﻮﻣﻮﺭ، ﺁﺩﻧﻮﻡ ﻏﻴﺮﻣﺘﺮﺷﺤﻪ ﻫﻮﺭﻣﻮﻥ ﺑﻮﺩﻩ ﻭ ﻣﻴﺰﺍﻥ ﺑﺮﻭﺯ ﻋﻮﺍﺭﺽ ﺩﺭ ﮐﻮﺗﺎﻩ ﻣﺪﺕ ﻭ ﻃﻮﻻﻧﻲ ﻣﺪﺕ ﺍﺯ ﺟﻤﻠﻪ ﺩﻳﺎﺑﺖ ﺑﻲﻣﺰﻩ، ﻧﺸﺖ ﻣﺎﻳﻊ ﻣﻐﺰﻱ ﻧﺨﺎﻋﻲ ﻭ ﺳﻴﻨﻮﺯﻳﺖ ﺩﺭ ﮔﺮﻭﻩ ﺁﻧﺪﻭﺳﮑﻮﭘﻴﮏ ﺑﻴﺸﺘﺮ ﺑﻮﺩ، ﺍﮔﺮﭼﻪ ﺗﮑﻨﻴﮏ ﺁﻧﺪﻭﺳﮑﻮﭘﻴﮏ ﺑﺎ ﻋﻮﺩ ﮐﻤﺘﺮ، ﻃﻮﻝ ﻣﺪﺕ ﺑﺴﺘﺮﻱ ﮐﻤﺘﺮ ﻭ ﻣﻮﻓﻘﻴﺖ ﺑﻴﺸﺘﺮ ﺩﺭ ﻧﺮﻣﺎﻝ ﺷﺪﻥ ﺳﻄﺢ ﻫﻮﺭﻣﻮﻥﻫﺎ ﻫﻤﺮﺍﻩ ﺑﻮﺩ )0/005> P(. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺩﺭ ﺻﻮﺭﺗﻴﮑﻪ ﺗﮑﻨﻴﮏ ﺁﻧﺪﻭﺳﮑﻮﭘﻴﮏ ﺑﺎ ﻭﺳﺎﻳﻞ ﻭ ﺗﺠﻬﻴﺰﺍﺕ ﻣﻨﺎﺳﺐ ﻭ ﺗﻮﺳﻂ ﺟﺮﺍﺡ ﺑﺎ ﺗﺠﺮﺑﻪ ﺍﻧﺠﺎﻡ ﺷﻮﺩ، ﺍﺯ ﻧﻈﺮ ﺳﺮﺍﻧﺠﺎﻡ ﺩﺭﻣﺎﻥ ﻣﻲﺗﻮﺍﻧﺪ ﺑﺎ ﺗﮑﻨﻴﮏ ﻣﻴﮑﺮﻭﺳﮑﻮﭘﻴﮏ ﻗﺎﺑﻞ ﻣﻘﺎﻳﺴﻪ ﺑﺎﺷﺪ، ﮔﺮﭼﻪ ﺑﺮﺍﻱ ﺑﻪ ﺩﺳﺖ ﺁﻭﺭﺩﻥ ﻧﺘﺎﻳﺞ ﺑﻬﺘﺮ ﻧﻴﺎﺯ ﺑﻪ ﻃﺮﺡ ﻣﻄﺎﻟﻌﺎﺕ ﮐﺎﺭﺁﺯﻣﺎﻳﻲ ﺑﺎﻟﻴﻨﻲ ﻣﻲﺑﺎﺷﺪ.

Introduction & Objective: With the introduction of endoscope in the field of neurosurgery since 1980, the approaches to the sellar region has been modified remarkably, and Endoscopic Transsphenoidal surgery for pituitary tumors is now a good alternative to the traditional Microscopic Transseptal approach with comparable results. Materials & Methods: All patients who were operated for pituitary adenoma using either endoscopic or microscopic transsphenoidal approaches from 2008 until 2012, were followed up on a regular basis by neuroimaging, pituitary hormonal study and neuro-ophtalmologic examination. Short-term and long-term complications, the rate of hormonal remission, visual improvement in long-term, and recurrence rate were compared between the two groups. Results: Forty one patients were included in this study. Thirty two cases were operated upon using the endoscopic approach, and 9 were operated upon by the microscopic approach. Null cell adenoma was the most common pituitary tumor in the series. The rate of short-term and long-term complications including DI, CSF leak, and sinusitis, were more common in the group who underwent endoscopic resection of pituitary adenoma, although this approach was associated with lower recurrence rate, less hospital stay, and more success in the rate of hormonal normalization (P > 0.005 for all variables). Conclusions: The present study suggests that endoscopic approaches to the sellar region can be done safely with comparable results with microscopic approaches in the experienced and well equipped hands, although prospective randomized studies are needed to address better results.