The Effect Of Intraoperative Intracavitary Electrocoagulation Timing On The Prognosis Of Patients With Non-functional Pituitary Adenomas

Objective:To investigate the effect of bipolar electrocoagulation hemostasis duration within the tumor cavity on postoperative sellar hemorrhage,pituitary function,and postoperative recurrence in patients with non functional pituitary adenomas during endoscopic transnasal transsphenoidal pituitary adenoma resection.Method:A retrospective analysis was conducted on 109 patients with non functional pituitary adenomas who underwent neuroendoscopic transsphenoidal pituitary adenoma resection by the same surgeon at Qilu Hospital,Shandong University from 2018 to 2022.According to the different duration of electrocoagulation hemostasis in the tumor cavity,62 people were divided into an observation group with a long electrocoagulation duration(electrocoagulation duration≥20s)and a control group with a short electrocoagulation duration(electrocoagulation duration<20s),with 47 people in the control group.Calculate the volume of sellar area bleeding 1 day after surgery using postoperative CT and our hospital’s imaging department’s intelligent uAI;Obtain FT4 and TSH levels at 3 days and 3 months after surgery,cortisol levels at 1 day and 3 months after surgery,and blood sodium levels within 7 days after surgery through serum tests;Record the daily urine volume of the patient for 5 days after surgery;Record the recurrence of pituitary adenomas in patients through telephone follow-up.Data analysis uses statistical methods such as inter group independent sample t-test,rank sum test,χ2 test,Kendall correlation analysis,partial correlation analysis,logistic regression analysis,and ROC curve equation.P<0.05 indicates a statistically significant difference.Result:The median duration of electrocoagulation in the observation group was 43.5 seconds(interquartile range 27.75-69.5 seconds),while the median duration of electrocoagulation in the control group was 5 seconds(interquartile range 4-8 seconds).The observation group had a bleeding volume of 1.86 ml(1.36-2.39 ml)in the sellar area one day after surgery,while the control group had a bleeding volume of 2.69 ml(2.37-3.21 ml),with a statistically significant difference(Z=5.131,P<0.001).The cortisol level in the observation group was 15.96 ug/dl(9.87-18.42 ug/dl)on the first day after surgery,compared to 20.41 ug/dl(13.46-24.37 ug/dl)in the control group,with a statistically significant difference(Z=2.848.P=0.004).There was no statistically significant difference in the levels of mesothelial alcohol between the two groups at 3 months after surgery.The lowest blood sodium level within 7 days after surgery was 136.5 mmol/1(133-139.25 mmol/1)in the observation group,and 137 mmol/1(135-140 mmol/1)in the control group,with a statistically significant difference(Z=1.995,P=0.046).There were 40 patients(64.5%)in the observation group who did not experience hyponatremia after surgery,14 patients(22.6%)with mild hyponatremia,2 patients(3.2%)with moderate hyponatremia,and 6 patients(9.7%)with severe hyponatremia;The control group had no postoperative hyponatremia in 38 patients(80.9%),mild hyponatremia in 7 patients(14.9%),and moderate hyponatremia in 2 patients(4.3%),with a statistically significant difference(χ2=8.677,P=0.034).There was no statistically significant difference in FT4 and TSH levels between the two groups at 3 days and 3 months after surgery;There was no statistically significant difference in the recurrence rate of pituitary adenomas between the two groups(follow-up time 6-58 months).The duration of bipolar electrocoagulation on the sellar septal surface,the cavernous sinus surface and the dorsal sellar surface was not related to the postoperative pituitary function.Conclusion:(1)Prolonging the intratumoral electrocoagulation time appropriately can reduce the volume of postoperative hemorrhage in the sellar region.(2)Prolonging the intratumoral electrocoagulation time may increase the incidence of low cortisol and hyponatremia in the short term after surgery.(3)Prolonging the intratumoral electrocoagulation time did not affect the long-term pituitary function and postoperative recurrence of patients.