The postoperative infections after endoscopic transsphenoidal surgery for growth hormone⁃secreting pituitary adenoma

Abstract

Objective To explore the characteristics, risk factors of postoperative infections for patients with growth hormone (GH)⁃secreting pituitary adenoma after endoscopic transsphenoidal surgery, and to share the experience of diagnosis and treatment of these patients. Methods A total of 122 patients with GH⁃secreting pituitary adenoma who underwent endoscopic transsphenoidal surgery were included from January 2016 to October 2019, and the data of postoperative body temperature, postoperative infection and related possible risk factors were analyzed. Results The incidence of postoperative infections in patients with acromegaly was significantly higher than that with other types of pituitary adenomas [9.84% (12/122) vs. 3.77% (8/212), P=0.025]. Central nervous system infection (7 cases) and bacteremia (4 cases) were the most common types of infections. Gram ⁃ negative bacilli were predominant (10 cases). The postoperative peak body temperature of patients with infections (12 cases) was significantly higher (P = 0.000) and appeared later than non ⁃infectious group (110 cases, P= 0.000). Multivariate Logistic analysis showed that intraoperative cerebrospinal fluid leakage (OR = 5.520, 95% CI:1.193-25.551; P = 0.029) and female (OR = 7.804, 95% CI: 1.088 - 55.948;P = 0.041) patients were major risk factors for postoperative infections. Conclusions For patients with GH ⁃ secreting pituitary adenoma who underwent endoscopic surgery, postoperative infections were uncommon but serious complication, especially for females, for those who experienced intraoperative cerebrospinal fluid leakage and postoperative peak body temperature delayed. Early identification and timely treatment are very important. Empirical anti ⁃ infective treatment should cover Gram ⁃ negative bacteria. Repair using autologous fat fascia and nasoseptal flap may reduce the incidence of postoperative infections in patients who suffered severe cerebrospinal fluid leakage.DOI：10.3969/j.issn.1672⁃6731.2020.03.013