Phẫu thuật qua ngách yết hầu nội soi so với phẫu thuật qua ngách yết hầu vi phẫu cho bệnh Cushing: một đánh giá hệ thống và phân tích tổng hợp

Pituitary - Tập 21 - Trang 524-534 - 2018
Leonie H. A. Broersen1,2, Nienke R. Biermasz1,2, Wouter R. van Furth2,3, Friso de Vries1,2, Marco J. T. Verstegen2,3, Olaf M. Dekkers1,4, Alberto M. Pereira1,2
1Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Leiden, The Netherlands
2Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
3Department of Neurosurgery, Leiden University Medical Centre, Leiden, The Netherlands
4Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands

Tóm tắt

Đánh giá hệ thống và phân tích tổng hợp so sánh phẫu thuật qua ngách yết hầu nội soi và vi phẫu đối với bệnh Cushing liên quan đến kết quả phẫu thuật (hồi phục, tái phát và tỷ lệ tử vong) và tỷ lệ biến chứng. Mục tiêu phân loại kết quả theo kích thước khối u. Chín cơ sở dữ liệu điện tử đã được tìm kiếm vào tháng 2 năm 2017 để xác định các bài báo có liên quan. Các nghiên cứu đoàn hệ đánh giá kết quả phẫu thuật hoặc tỷ lệ biến chứng sau phẫu thuật qua ngách yết hầu nội soi hoặc vi phẫu cho bệnh Cushing đủ điều kiện tham gia. Các tỷ lệ nhóm được báo cáo bao gồm khoảng tin cậy 95%. Chúng tôi đã bao gồm 97 bài báo với tổng cộng 6695 bệnh nhân (5711 bệnh nhân được phẫu thuật bằng vi phẫu và 984 bệnh nhân được phẫu thuật bằng nội soi). Tổng thể, 5177 bệnh nhân đã đạt được hồi phục (80%), không có sự khác biệt đáng kể giữa hai kỹ thuật. Tỷ lệ tái phát khoảng 10% và tỷ lệ tử vong ngắn hạn < 0.5% cho cả hai kỹ thuật. Rò dịch não tủy xảy ra thường xuyên hơn trong phẫu thuật nội soi (12.9% so với 4.0%), trong khi đái tháo nhạt thoáng qua xảy ra ít hơn (11.3% so với 21.7%). Đối với microadenoma, kết quả tương đương giữa hai kỹ thuật. Đối với macroadenoma, tỷ lệ bệnh nhân hồi phục cao hơn sau phẫu thuật nội soi (76.3% so với 59.9%), và tỷ lệ tái phát thấp hơn sau phẫu thuật nội soi (1.5% so với 17.0%). Phẫu thuật nội soi đối với bệnh nhân mắc bệnh Cushing đạt được kết quả tương đương cho microadenomas và có thể tốt hơn cho macroadenomas so với phẫu thuật vi phẫu. Điều này mặc dù giả định về việc làm quen với kỹ thuật nội soi mới này, mặc dù không thể loại trừ sự nhiễu loạn. Dựa trên nghiên cứu này, phẫu thuật nội soi có thể được xem xét như tiêu chuẩn chăm sóc hiện tại. Phẫu thuật vi phẫu có thể được thực hiện dựa trên sở thích của bác sĩ phẫu thuật thần kinh. Các chuyên gia nội tiết và bác sĩ phẫu thuật thần kinh tại các trung tâm yết hầu thực hiện kỹ thuật vi phẫu nên ít nhất xem xét việc chuyển gửi bệnh nhân mắc bệnh Cushing có macroadenoma.

Từ khóa

#phẫu thuật qua ngách yết hầu #nội soi #vi phẫu #bệnh Cushing #hồi phục #tái phát #tỷ lệ tử vong #biến chứng

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