Analysis Of Common Complications And Risk Factors Of Endoscopic Resection Of Pituitary Cell Adenoma

Objective:The risk factors of common complications of endoscopic transsphenoidal resection of pituitary tumor were summarized and to provide a theoretical reference for reducing the incidence of postoperative complications.Methods:In this study,the clinical data of 102 patients diagnosed with pituitary adenoma in the 10 th ward of neurosurgery department of Tianjin Huanhu hospital from January20,2018 to July 20,2019 was collected and retrospectively analyzed.First of all,the application of two independent samples nonparametric test and chi-square were applied to the patient’s age,sex,body mass index,history of drinking,history of smoking,history of heart disease,history of diabetes mellitus,preoperative endocrine disorder,tumor size,tumor invasiveness,whether the tumor is accompanied by cystic changes or stroke,operation length,existence of factors such as cerebrospinal fluid leakage during the operation.Finally,find out the factors with statistical significance(p <0.05)and perform multivariate logistic regression analysis to find the independent risk factors of postoperative complications.Results:A total of 102 patients were included in this group and the results of each complication were described in the following sections: 1)The single factor analysis of postoperative cerebrospinal fluid leak suggest that there is significant difference(P< 0.05)between the existence of intraoperative cerebrospinal fluid leakage and the size of the tumor,operation length,tumor invasiveness,body mass index(BMI),statistically significant factors were analyzed by multiariable logistic regression analysis showing intraoperatie cerebrospinal fluid leakage(OR: 7.933)is the independent risk factors for postoperative cerebrospinal fluid leakage,the odds ratio is greater than 1,that is,the patients with cerebrospinal fluid leakage during surgery have a higher risk of cerebrospinal fluid leakage after surgery.2)According to the results of single factor analysis there are significant differences between postoperativeintracranial infection and tumor size,operation length,existence of cerebrospinal fluid leakage during operation,cerebrospinal fluid leakage after operation(P < 0.05),Multivariate logistic regression analysis of the statistically significant results obtained showed that postoperative cerebrospinal fluid leakage(OR: 32.766)was an independent risk factor of postoperative intracranial infection.3)According to the results of single factor analysis,there is a difference(P <0.05)between postoperative diabetes insipidus,existence of preoperative endocrine disorder(ie,functional tumor)and tumor invasiveness.Multivariate logistic regression analysis of the statistically significant results obtained,suggested that preoperative endocrine disorders(ie,functional tumors)were independent risk factors for postoperative diabetes insipidus,with an OR value of 2.643.The main risk factor of postoperative diabetes insipidus after transsphenoidal pituitary surgery is preoperative endocrine disorder.4)According to the results of single factor analysis,there is a significant difference(P<0.05)between the postoperative electrolyte disturbance,existence of preoperative endocrine disorder(i.e.functional tumor),tumor invasiveness and postoperative diabetes insipidus.The results with statistical differences were analyzed by multivariate logistic regression analysis,suggesting that the above three risk factors are not the independent risk factors for postoperative electrolyte disturbance.Electrolyte disturbance after transsphenoidal pituitary surgery is not caused by a single factor,may be the result of combined action of several risk factors.5)According to the results of single factor analysis,there is a significant difference(P <0.05)between postoperative hypophysis,tumor size and its invasiveness.The statistically significant results obtained are analyzed by multivariate logistic regression analysis and suggested that the size of the tumor is an independent risk factor for postoperative pituitary dysfunction,that is,large pituitary adenoma(tumor greater than or equal to 3 cm)is more likely to have pituitary dysfunction after surgery.6)According to the results of single factor analysis,there is a significant difference(P < 0.05)between patients with postoperative bleeding,operation length and tumor invasiveness.The results with statistical differences obtained by multivariate logistic regression analysis suggest that both factors above are not the independent risk factors for postoperative bleeding after transsphenoidal pituitarysurgery.Postoperative bleeding after transsphenoidal pituitary surgery is not caused by a single factor,may be the outcome of combined action of several risk factors.Conclusions:Through the study of this group of data,it was found that the risk factors of postoperative complications after transsphenoidal endoscopic pituitary tumor surgery were mainly as follows:(1)Postoperative cerebrospinal fluid leakage was related to intraoperative cerebrospinal fluid leakage;(2)Postoperative intracranial infection is related to postoperative cerebrospinal fluid leakage;(3)The probability of occurrence of postoperative diabetes insipidus increased in patients with endocrine disorder before operation;(4)The greater the tumor volume,the greater the risk of postoperative hypophysis;(5)Postoperative water and electrolyte disturbance may be related to preoperative endocrine disorder,tumor invasiveness,and postoperative diabetes insipidus.(6)Long operation time(greater than or equal to 3h)and invasive tumor may be related to postoperative bleeding.In short,through the study and analysis of the risk factors of complications of transsphenoidal endoscopic surgery,the surgeon can have more understanding of the risk factors of postoperative complications,so as to reduce the incidence of postoperative complications as much as possible.