Comparison Of Treatment Outcomes Of Different Surgical Approaches For Treating Giant Pituitary Adenoma And Comprehensive Treatment

Objective: The object of this study was to compare surgical outcomes, including rate of gross tumor removal and rate of successful symptom remission, average hospitalization days, situation of complications, recurrence rate and recurrence time in a contemporaneous series of patients undergoing surgical operations through different approaches for pituitary macroadenomas. Provided the reference for future clinical work of choosing the operation method.Methods:Data were collected from 76 patients whose surgery had occurred in the period from January 2012 to December 2015 in First Hospital of Jilin University. Patients who in accordance with the set of conditions and underwent microscopic transnasal-transphenoidal, craniotomic or two-stage surgery for pituitary macroadenomas were included in the study. Eligible patient records were analyzed for outcomes, complications, hospital days and recurrence conditions. Statistical analyses were performed on these data using SPSS 20.0. The results were used to compare the outcomes after different surgical approaches.Provide reference in later clinical surgical options.Outcome:According to the inclusion criteria, data from 76 patients.29 patients (38.2%) underwent microscopic transsphenoidal surgery,1 patient died after surgery,20 patients (26.3%) underwent craniotomic surgery,2 patient died after surgery and 27 patients (35.5%) underwent two-stage surgery,2 patient died after surgery. Rate of gross tumor removal for microscopic transsphenoidal surgery was 57.1%, the rate for craniotomic surgery is 55% and the rate for two-stage surgery is 81.5%. There are statistical differences in rates of gross tumor removal after different surgical perations (p=0.047T 0.05). Further analysis indicated that there was statistical difference between the rates of gross tumor removal of microscopic transsphenoidal surgery and twostage surgery (p=0.019) while the difference between two-stage surgery and craniotomic surgery (p= 0.05) and the differences between craniotomic surgery and microscopic transsphenoidal surgery both were not statistically significant. The recurrence rate of transsphenoidal in follow-up period is (7/29) 24.1% craniotomy recurrence rate is(4/20) 20%, two surgical relapse rate is(4/27) 14.8%. After statistical analysis, P> 0.05, not statistically significant. Postoperative remission rate transsphenoidal group (21/29) 65.5% craniotomy group (13/20) 70%, second stage surgery group (22/27) 77.8%, due to the smal I number of sampl es, no statistics were each symptom, there is an error, P>0.05, not statistically significant. Transsphenoidal group after an average hospital stay of 6.1 days, craniotomy group was 11.3 days, two surgical group was 15.1 days, and days of hospitalization transsphenoidal group was significantly shorter. Postoperative complications of microscopic transsphenoidal surgery is significantly less than two-stage surgery and craniotomic surgery.Conclusion:(1 )Rate of gross tumor removal and recurrence rate for microscopic transsphenoidal surgery is below than the rate of two-stage surgery, tumor resection is difficult, low postoperative mortality, fewer postoperative complications, intracranial trauma smaller than the other two, length of hospital stay was significantly shorter, symptom recovery is satisfactory.(2) Craniotomy surgery operations a larger space, easy hemostasis and to remove the tumor under direct vision, rate of gross tumor removal was slightly higher than transsphenoidal group, but surgical trauma is larger, postoperative complications is more than transsphenoidal group, meet the conditions craniotomy should choose the surgical.(3) The rate for two-stage surgical resection of giant pituitary adenoma is better than transsphenoidal craniotomy group and craniotomy group, recurrence rate is low, with a certain risk of death after surgery, but a higher rate of symptom remission, results were satisfactory.(4) We should combine radiation therapy and drug treatment based on the condition of residual tumor after surgery for individual treatment, to control tumor growth as far as possible and improve the survival and quality of life.