肢端肥大症患者的手术效果:显微镜与内窥镜经蝶手术

IF 6.1 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Best practice & research. Clinical endocrinology & metabolism Pub Date : 2024-07-01 DOI:10.1016/j.beem.2024.101879
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引用次数: 0

摘要

经蝶窦切除分泌生长激素的垂体神经内分泌肿瘤仍然是治疗肢端肥大症的一线疗法。这种手术可以通过显微外科手术或内窥镜手术进行。过去几十年来,内窥镜手术已成为全球越来越多中心的首选技术。然而,内窥镜手术是否能提供更优越的临床疗效仍有待确定。在本文中,我们对这两种治疗肢端肥大症的技术进行了文献综述。我们从客观的角度对现有的比较研究进行了批判性评估,以确定这些研究是否适合定义两种技术的优越性。现有证据在方法上存在很大差异,报告的结果也相互矛盾。虽然内窥镜手术能使手术视野更开阔,能见度更高,但这并不能持续转化为更好的临床结果,因为大多数肿瘤在两种技术下都能被同样地触及。两种技术的术后效果(如缓解率和并发症发生率)相似。无论采用哪种方法,都应由经验丰富的垂体神经外科医生进行肢端肥大症的治疗。在专门的垂体中心,多学科团队的参与对于确保最佳疗效至关重要。
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Surgical outcomes in patients with acromegaly: Microscopic vs. endoscopic transsphenoidal surgery

Transsphenoidal resection of growth hormone-secreting pituitary neuroendocrine tumors remains the first-line treatment for acromegaly. This can be performed through microsurgery or endoscopic surgery. For the past decades, endoscopic surgery has become the preferred technique in an increasing number of centers worldwide. However, whether it offers superior clinical outcomes has yet to be determined. In this paper, we performed a narrative review of the literature comparing both techniques in the treatment of acromegaly. We critically assessed available comparative studies from an objective perspective to determine their suitability for defining superiority of either technique. Available evidence displays substantial methodological variations and reports conflicting findings. Although endoscopic surgery provides a wider exposure and enhanced visibility of the surgical field, this does not consistently translate into better clinical outcomes, as most tumors are equally accessible through both techniques. Postoperative outcomes such as remission and complication rates are similar between both techniques. The management of acromegaly should be performed by experienced pituitary neurosurgeons, regardless of the approach. The involvement of a multidisciplinary team in a dedicated pituitary center is critical to ensure optimal outcomes.

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来源期刊
CiteScore
11.90
自引率
0.00%
发文量
77
审稿时长
6-12 weeks
期刊介绍: Best Practice & Research Clinical Endocrinology & Metabolism is a serial publication that integrates the latest original research findings into evidence-based review articles. These articles aim to address key clinical issues related to diagnosis, treatment, and patient management. Each issue adopts a problem-oriented approach, focusing on key questions and clearly outlining what is known while identifying areas for future research. Practical management strategies are described to facilitate application to individual patients. The series targets physicians in practice or training.
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