Tsvirinko I. Improvement of endonasal surgical treatment efficiency in management of patients with benign neoplasms of the sellar area

The dissertation deals with the problem of improving the effectiveness of treatment, by improving endoscopic endonasal transsfenoidal approaches, determining the rhinological complications and predicting the postoperative period in patients with benign neoplasms of the sellar area and cavernous sinus. The dissertation is based on a comprehensive clinical and instrumental study of the nasal cavity and paranasal sinuses, respiratory function of the nasal cavity and quality of life of 18 patients with endoscopic endonasal transseptal (control group), 47 patients with endoscopic endonasal commons (comparative group) and 64 patients with endoscopic endonasal preserved access methods (main group). The infiltration method of the anterior wall of the sphenoid sinus has been developed, which improves visualization and reduces bleeding (to 0-1 degrees on the Andre. P. Boezaart scale) during the nasal phase of endoscopic endonasal removing of tumors. The preserved transsfenoidal method of approach was developed with the preservation of the sphenoethmoidal mucosa and intranasal structures. It was established that the endoscopic endonasal access to the sellar area by the proposed method contributed to: a significant decrease the number of patients with the presence of crust in 3 times on the 7th day after surgical intervention compared with the control group; a significant reduction the number of patients with the presence of mucous discharge in the nasal cavity on 7th day (in 2 times compared with patients who used the common method (p <0.05)). 3rd months after surgery, patients with the main group of atrophic changes of the mucosa were not observed (in the comparison group 16.7% of the patients observed atrophic changes of nasal mucosa). Treated with our improved method of the access occurred in 3 times frequently less ethmoiditis, and 4 times less frequently observed sphenoiditis during the postoperative period. Preservation of the nasal structures contributed to a significantly higher quality of life (according to the SNOT-20 questionnaire) in the postoperative period throughout the observation period. For the first time, the study of the respiratory function of the nasal cavity in patients after various methods of endoscopic endonasal transsfenoidal approaches to the SA. It was found that after 3 months after surgical intervention in the patients of the main group, the air flow rates were 115-130% of the normative values, which was significantly higher than in patients after the application of the generally accepted method (80-95%). After 6 months, the indicators in the main group remained at the level of 120-130%, and the rates of patients in the comparison group increased to 90-115%.