经鼻垂体腺瘤切除术后复发相关因素的研究

发布时间：2018-01-17 12:34

本文关键词：经鼻垂体腺瘤切除术后复发相关因素的研究　出处：《天津医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:垂体腺瘤为颅内最常见的鞍区占位性病变,近年来,经鼻垂体腺瘤切除术已经广泛应用于垂体腺瘤的治疗当中,但因其有着比较高的复发率,为临床医生及患者带来很多困扰。本研究试图通过分析影响经鼻垂体腺瘤切除术后复发的相关因素,找寻更有效的治疗方法,降低术后复发率,为垂体腺瘤患者提供更有效的治疗方案,从而提高临床治愈率,减轻垂体腺瘤患者的痛苦。方法:回顾性分析自2004年1月-2011年1月于天津市环湖医院行经鼻垂体腺瘤切除术的102例患者,通过病例采集记录所有患者的临床特征,包括:性别、发病年龄、肿瘤有无功能性、肿瘤最大直径、临床症状、肿瘤有无侵袭性、肿瘤是否残留、是否结合术后辅助治疗、是否合并垂体卒中及手术方式(显微镜下或内镜下经鼻蝶垂体腺瘤切除术)等,记录患者定期复查时的随访结果并计算复发率,采用Logistic逐步回归分析法,得出影响经鼻垂体腺瘤切除术后复发的相关因素,并分析其可能的因素。卡方检验分析残留在海绵窦内外的肿瘤组织的复发率是否存在差异。Fisher确切概率法分析功能性垂体腺瘤中各个临床症状与术后复发的关系。结果:4-60个月(平均随访时间38.4个月)的随访过程中,102例患者有21例(20.5%)复发,复发时间最短为术后10个月,最长为术后5年,平均复发时间为术后48.5个月。通过对性别、发病年龄、肿瘤有无功能性、肿瘤最大直径、肿瘤有无侵袭性、肿瘤是否残留、是否结合术后辅助治疗、肿瘤是否合并卒中及手术方式等临床特征进行Logistic逐步回归分析可得出,影响经鼻垂体腺瘤切除术后复发的因素包括:肿瘤残留(p=0.001)、肿瘤侵袭性(p=0.033)、肿瘤合并垂体卒中(p=0.029)及术后结合辅助治疗(p=0.023),而性别、发病年龄、肿瘤最大直径、肿瘤有无功能性及手术方式与经鼻垂体腺瘤切除术后复发无明显相关性(p值均0.05)。对术后肿瘤有残留的病例进一步分析发现肿瘤残留位置(海绵窦内或外)与术后复发无明显相关性(p=0.288)。虽然肿瘤有无功能性对肿瘤复发无明显影响,但功能性垂体腺瘤中伴有月经失调临床症状的复发率明显高于伴有其他症状者,需严格进行定期复查。肿瘤直径越大(尤其是大于10mm),相较于体积小的肿瘤复发率高,应视为肿瘤复发的危险因素。结论:本研究通过分析表明,垂体腺瘤伴有卒中、肿瘤具有侵袭性及术后肿瘤残留增加术后复发发生的风险,术后结合辅助治疗可以使术后复发率降低,性别、发病年龄、肿瘤最大直径、肿瘤有无功能性及手术方式与经鼻垂体腺瘤切除术后复发无明显相关性。根据本研究得出的结论,可以帮助临床医师总结患者术前情况,并结合临床症状综合分析病情,制定有效的治疗方法,提高经鼻垂体腺瘤切除术的整体治愈率。
[Abstract]:Objective: pituitary adenoma is the most common intracranial lesions in the Sellar area. In recent years, transnasal pituitary adenomectomy has been widely used in the treatment of pituitary adenomas, but it has a high recurrence rate. This study attempts to find a more effective treatment to reduce the postoperative recurrence rate by analyzing the related factors affecting the recurrence of pituitary adenoma after transnasal pituitary adenoma resection. To provide a more effective treatment for patients with pituitary adenoma, so as to improve the clinical cure rate. Methods: from January 2004 to January 2011, 102 patients with pituitary adenoma were treated with transnasal pituitary adenectomy at Tianjin Huanghu Hospital. The clinical features of all patients were recorded by case collection, including: sex, age of onset, function of tumor, maximum diameter of tumor, clinical symptoms, tumor invasiveness and residual tumor. Whether to combine with postoperative adjuvant therapy, whether to combine pituitary apoplexy and operation (microscopical or endoscopic transsphenoidal pituitary adenomectomy), to record the follow-up results and calculate the recurrence rate. Logistic stepwise regression analysis was used to determine the factors affecting the recurrence of pituitary adenomas after resection. Chi-square test was used to analyze the recurrence rate of residual tumor tissues inside and outside the cavernous sinus. Fisher exact probability method was used to analyze the clinical symptoms and postoperative outcomes of functional pituitary adenomas. The relation of recurrence. Result:. 4-60 months (. The mean follow-up time was 38.4 months. The recurrence time was 10 months, the longest was 5 years, and the average recurrence time was 48.5 months. Whether the tumor is functional, the tumor has the largest diameter, whether the tumor has invasiveness, whether the tumor remains or not, and whether it is combined with postoperative adjuvant therapy. Logistic stepwise regression analysis can be used to determine whether the tumor is associated with stroke and surgical methods. The factors influencing the recurrence of pituitary adenoma after transnasal pituitary adenoma resection were as follows: residual tumor was 0.001, tumor invasiveness was 0.033). Tumor complicated with pituitary apoplexy (p0.029) and postoperative adjuvant therapy (p0.023), sex, age of onset, maximum diameter of tumor. There was no significant correlation between tumor function and operative method and recurrence of pituitary adenoma after transnasal pituitary adenoma resection (P < 0.05). There was no significant correlation between intra and outer cavernous sinus recurrence and postoperative recurrence, although the function of the tumor had no significant effect on the recurrence of the tumor. However, the recurrence rate of functional pituitary adenomas with menstrual disorders is significantly higher than that of patients with other symptoms. The larger the tumor diameter is (especially > 10mm), the more periodic reexamination is required. Compared with the small tumor recurrence rate, it should be considered as a risk factor for tumor recurrence. Conclusion: this study shows that pituitary adenoma is associated with stroke. Tumor invasiveness and residual tumor increase the risk of recurrence after surgery, postoperative combined with adjuvant treatment can reduce the recurrence rate, sex, age of onset, tumor maximum diameter. There is no significant correlation between the tumor function and the operation method. According to the conclusion of this study, it can help clinicians to sum up the preoperative situation of patients. Combined with clinical symptoms and comprehensive analysis of the disease, an effective treatment method to improve the overall cure rate of transnasal pituitary adenoma resection.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R736.4

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