内镜经鼻蝶垂体瘤切除术后患者视野的恢复及影响因素

发布时间：2018-02-17 03:10

本文关键词： 视野缺损垂体瘤内镜经鼻蝶垂体瘤切除术视力　出处：《新疆医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：视野检查在视路疾病的诊断上具有重要意义,而垂体腺瘤是造成视交叉损害较常见的病变。此研究对垂体腺瘤患者的术前及术后视野进行定量评估,观察患者行单鼻孔内镜下经鼻蝶垂体瘤切除术后视野恢复,探讨术后视野恢复的影响因素。方法：回顾性分析新疆医科大学第一附属医院2012年3月至2013年3月经MRI检查确诊为垂体瘤的患者78例(156只眼),于术前行视力、视野、眼底荧光造影及垂体MRI平扫加增强检查。术前全部行中心视野检查,于术后7天内,3-6个月进行视力、中心静态视野评估,并行垂体MRI平扫加增强检查,内分泌检查。对影响因素进行单因素分析和多因素Logistic回归分析。结果：视野缺损在颞上象限的频率最高,其次是颞下。术后3-6个月的随访中,患者视野的恢复是渐进的过程。总体来说,31.7%的眼睛视野恢复正常,术后视野改善59.1%,在9.2%保持不变。在单因素分析中,视野恢复正常组比视野改善组有一个较短的术前症状持续时间(P0.05)、更好的术前视力(P0.05),并在术前视野缺损的量值MD (the mean deviation)较小(P0.01),在多因素分析中,预测术后视野恢复积极的独立的因素为术前低MD绝对值(P=0.008),,小的肿瘤最大直径(P=0.04),和年轻的年龄(P=0.001)。结论：在单鼻孔内镜下垂体瘤切除术后,随访6个月后,视野逐步恢复正常和改善的有89.7%的病人。预测术后视野恢复积极的独立的因素为术前低MD绝对值,较小的肿瘤直径和年轻的年龄。
[Abstract]:Objective: visual field examination plays an important role in the diagnosis of optic diseases, and pituitary adenoma is a common lesion causing optic chiasma damage. To observe the recovery of visual field after transsphenoidal pituitary adenoma resection under single nostril endoscope. Methods: 78 patients with pituitary adenoma diagnosed by MRI from March 2012 to 2013 in the first affiliated Hospital of Xinjiang Medical University were treated with visual acuity and visual field before operation. All patients underwent central visual field examination before operation, visual acuity was performed 3-6 months after operation, central static visual field was evaluated, pituitary MRI plain scan and enhanced pituitary examination were performed. Endocrine examination. Univariate analysis and multivariate Logistic regression analysis of influencing factors. Results: the frequency of visual field defect was the highest in the superior temporal quadrant, followed by subtemporal. The recovery of visual field was a gradual process. In general, 31. 7% of the visual field returned to normal, the postoperative visual field improved 59. 1%, and remained unchanged in 9.2%. The patients with normal visual field recovery had a shorter duration of preoperative symptoms and better preoperative visual acuity than those with improved visual field (P 0.05), and the preoperative visual field defect (MD the mean deviation) was smaller than that of the visual field improvement group (P 0.01). The independent predictors of postoperative visual field recovery were preoperative low MD absolute value (P < 0.008), small tumor maximum diameter (P < 0.04), and young age (P < 0.001). Conclusion: after single-nostril endoscopic pituitary adenoma resection, the patients were followed up for 6 months. There were 89.7% patients whose visual field gradually returned to normal and improved. The independent factors of predicting the positive recovery of postoperative visual field were preoperative low MD absolute value, small tumor diameter and young age.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.41

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