ÖZGÜR KARDEŞ, EMRE DURDAĞ, SONER ÇİVİ, Halil Ibrahim SUNER, KADİR TUFAN, MELEK EDA ERTÖRER, ÖZLEM ÖZMETE

TRANSNAZAL TRANSSFENOİDAL HİPOFİZ CERRAHİSİNDE ERKEN POSTOPERATİF DÖNEMDE HASTA YÖNETİMİ

Amaç: Hipofiz adenomlar› ço¤unlukla iyi huylu kitlelerdir. En s›k olarak mikroskopik transnazal transsfenoidal (MTNTS) yolla opere edilmektedirler. Bu yaz›da, bahsedilen yolla yap›lan operasyonlar sonras› erken postoperatif dönemde yaflad›¤›m›z baz› komplikasyonlar ve komplikasyonlar›n yönetiminde multidisipliner yaklafl›m›n önemi incelenmifltir. Yöntem: 2012- 2018 y›llar› aras›nda hastanemizde nöroendokrin ekibince takip edilen ve MTNTS yolla ameliyat edilen 135 vakan›n verileri, radyolojik görüntüleri, retrospektif yaklafl›mla tarand›. Hastalar›n yafllar›, cinsiyetleri, baflvuru nedenleri, hipofiz adenomlar›n›n türü, erken dönemde görülen komplikasyonlar ve yo¤un bak›m yönetimleri incelendi. Yo¤un bak›mda kal›fl süreleri, hastanede toplam kal›fl süreleri ve haz›rl›k, operasyon tekni¤i ve baz› teknik ayr›nt›lar da gözden geçirildi. Bulgular: 135 hastan›n 80’inin kad›n 55’inin erkek oldu¤u ve ortalama yafl›n 47 oldu¤u görüldü. En s›k görülen alt tipin 51 (%37) olgu ile non-fonksiyone adenomlar oldu¤u saptand›. Hastalar›n 81’inin (%60) hormonal bozukluk nedeniyle tan› ald›¤› görülmekteydi. Erken dönem komplikasyonlara bak›ld›¤›nda 32 hastada operasyon esnas›nda beyin omurilik s›v›s› (BOS) fistülü (%23.7) görüldü¤ü, bu hastalar›n hepsine lomber drenaj tak›larak sella taban onar›m›n›n özenle yap›lmas› sonras› hiçbir hastada revizyon cerrahisi gerektirecek BOS fistülü - rinore geliflmedi¤i izlendi. On hastada yeni tan› olarak diabetes insipitus geliflti¤i (D‹) görüldü. Ortalama yat›fl süreleri incelendi¤inde yo¤un bak›mda ortalama kal›fl süresinin 1 gün, hastanede ortalama kal›fl süresinin ise 4 gün oldu¤u tespit edildi. Sonuç: Sellar kitlelerin cerrahi tedavisinde MTNTS cerrahi güvenilir bir cerrahidir ancak hastalar›n olas› komplikasyonlar aç›s›ndan postoperatif dönemde konuyla ilgili ve tecrübeli anestezi ve endokrinoloji uzmanlar›yla birlikte takip edilmeleri gerekti¤i kanaatindeyiz.

EARLY POSTOPERATIVE MANAGEMENT OF PATIENTS IN TRANSNASAL TRANSSPHENOIDAL PITUITARY SURGERY

Objective: Pituitary adenomas are mostly benign masses. They are most frequently operated on microscopic transnasal transsphenoidal (MTNTS) routes. This study was performed in order to examine the complications in the early post-operative period and underline the importance of multidisiplinary approach. Method: Between 2012 and 2018, 135 cases that has followed by neuroendocrine team and operated via MTNTS approach were investigated retrospectively. The age and gender of patients, reasons for referral, type of adenomas, early complications and management approaches were examined. The length of inhospital stay and some technical details were also reviewed. Results: Of the 135 patients, 80 were female, 55 were male, and the mean age was 47. The most common subtype was non-functioning adenomas with 51 cases. 81 of the patients (60%) were diagnosed due to hormonal imbalance. Cerebrospinal fluid (CSF) fistula (23.7%) was seen in 32 patients and revision surgery was required in none of them. In 10 patients diabetes insipitus (DI) was seen. Average stay in ICU and total hospital stay was one and four days, respectively. Conclusion: MTNTS surgery is a reliable approach, but its complications must be managed well. We consider that it should be followed up with an experienced anesthesiologist and endocrinology team in post-operative ICU

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