The Analysis Of Effect Of Endoscopic Endonasal Transsphenoidal Approach For Growth Hormone-secreting Pituitary Adenoma

Objective: To evaluate the efficacy and safety of endoscopic transsphenoidal approach in the treatment of growth hormone secreting pituitary adenoma,analysis clinical data of patients before and after surgery,and to investigate the effect of the remission rate and its related factors,to explore the way to improve the operation efficiency and reduce the postoperative complications.Methods: A retrospective analysis of the period from June2012 to June 2016 in the Department of Neurosurgery of the First Affiliated Hospital of Xinjiang Medical University patients accepted endoscopic transsphenoidal pituitary tumor resection and according to clinical features and postoperative immunohistochemical pathology results,GH neoplasia,clinical data were collected.According to the clinical features,radiological findings,tumor type,growth pattern,preoperative growth hormone and endocrine are classified according to the postoperative hormone levels,imaging manifestations and complications to evaluate the operation safety and efficacy,and to explore the related factors affecting the surgical results.Results: In 72 patients,41 patients achieve endocrine,overall response rate was 56.94%,micro adenoma,big gland,large adenoma postoperative remission rate was 88.9%,56.9% and 33.33% respectively,there is statistical significance between groups(P < 0.05).In total 43 cases of non-invasive adenoma,31 cases reduced(72.1%),and 10 cases(34.5%)of the total 29 cases of adenoma were reduced(34.5%),and the two were statistically significant(P < 0.05).In all50 cases,41 cases were reduced,13 cases were total and 9 were not relieved.Preoperative GH?10?g/L all 9 cases reduced,preoperative GH level 10 to 30?g /L ease the 29 cases of 20 cases reduced,34 cases GH?30?g /L 12 cases reduced,the response rate was100%,69.0% and 35.3%,respectively,each group has statistical significance(P < 0.05).Postoperative complications including cerebrospinal fluid leakage(3 cases),nasal intracranial infection(5 cases),4 cases of hemorrhage correlation complications,hyposmia(5 cases),urine collapse in all 7 cases,8 cases of electrolyte disorder,the secondary cavity sella syndrome in 1 case,6 cases vision impaired eyesight,no deaths occurred.Conclusion: Endoscopic transsphenoidal approach is safe,effective treatment for growth hormone secreting pituitary adenoma,for the growth of the noninvasive adenomas has high endocrine response rate.Endocrine remission rate after the operation,and the size of the tumor,the growth way,adenoma invasive,resection rate,preoperative GH levels of the hormone and so on,aggressive and preoperative tumor growth hormone levels more obvious influence on postoperative endocrine ease.Comprehensive preoperative evaluation,master the anatomical structure of nasal cavity and sella area,make full use of the sella area head CT three-dimensional reconstruction and CTA,intraoperative ultrasound guidance,accurate identification of endoscopic two-dimensional images under various anatomical symbol is the premise to improve operation safety.