垂体瘤术后尿崩症相关影响因素分析及防治方法探讨

发布时间：2018-03-11 03:24

本文选题：垂体瘤　切入点：尿崩症　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景垂体腺瘤是神经外科常见的一种神经内分泌性肿瘤,其主要源于腺垂体,但也可起源于神经垂体及颅咽管残余细胞[1]。据最新调查显示其患病率为7.5~15/10万人,占颅内肿瘤的8%~15%[2]。当前,垂体瘤的治疗是以手术切除为主,同时联合药物及放射治疗为辅助方式的综合治疗方法。17世纪80年代,Horsley年采取经颅入路,完成了世界上首台垂体瘤切除术。经蝶入路由Schloffe于18世纪初始创,但因当时照明设备、手术器械不佳,导致术中肿瘤暴露不良,止血困难及术后并发症较多等原因,致使该术式并未得以广泛应用。20世纪60年代手术显微镜应用到临床,Hardy于1967年首次将其应用到经蝶垂体瘤切除术,凭借其放大及良好照明的优点,大大提高了手术效果。经蝶垂体瘤切除术因其肿瘤切除率高、创伤小、术后患者反应轻,并发症少,恢复快,患者住院周期短等优势,目前较经颅垂体瘤切除术应用更广泛。但一些向鞍上及鞍旁发展的肿瘤,依然需要通过经颅手术切除。垂体瘤术后并发症主要包括:鞍内出血、鼻出血、脑脊液漏、颅内感染、尿崩症、垂体功能减退、眼肌麻痹、鼻中隔穿孔等。而尿崩症是垂体瘤术后最常见的并发症之一。研究目的总结大连医科大学附属第二医院2009~2017年期间120例行垂体瘤切除术患者的病历资料,分析垂体瘤术后尿崩症与年龄、性别、肿瘤大小、肿瘤内分泌功能类型、肿瘤侵袭性、肿瘤生长方向(是否突破鞍隔)、手术方式以及肿瘤切除程度等因素的关系,探讨垂体瘤术后尿崩症的发病机理及诊治方法。研究方法运用SPSS19.0统计分析软件进行统计分析,计量资料采用t检验,计数资料采用X2检验,首先进行单因素分析,分析不同因素与垂体瘤术后尿崩症的相关性,将单因素分析中存在统计学差异的指标再进行多因素Logistic分析,p≤0.05时差异有统计学意义。研究结果120例垂体瘤手术患者中,术后出现尿崩症37例,尿崩症发生率为30.8%。经过统计分析结果显示:肿瘤大小是术后尿崩症的独立影响因素(W=5.742P=0.017 OR=10.894)。肿瘤生长方式是术后尿崩症的独立影响因素(W=4.351P=0.026 OR=0.035)。尿崩症发生率,大腺瘤大腺瘤为腺瘤,突破鞍隔向鞍上侵犯的垂体瘤较未突破鞍隔者更易发生尿崩。而尿崩症的发生与年龄、性别、肿瘤内分泌功能类型、肿瘤侵袭性、手术方式及肿瘤切除程度无关(P0.05)。结论1.垂体瘤术后尿崩症的发生与肿瘤大小、肿瘤生长方向(突破鞍隔)有关,而与年龄、性别、肿瘤内分泌功能类型、肿瘤侵袭性、手术方式及肿瘤切除程度无关。尿崩发生率大腺瘤大腺瘤为腺瘤,突破鞍隔向鞍上侵犯的垂体瘤较未突破鞍隔者更易发生尿崩症。2.术中注意保护下丘脑、垂体柄、垂体后叶组织及其血供,术后及时准确的诊断和治疗,是防治垂体腺瘤术后尿崩症的关键。
[Abstract]:Background pituitary adenoma is a common neuroendocrine tumor in neurosurgery. It is mainly derived from the pituitary gland, but also from the residual cells of the neurohypophysis and craniopharynx [1]. 8% of intracranial tumors [2] .At present, the main treatment of pituitary adenoma is surgical resection, combined with drugs and radiotherapy as a supplementary method. In 80s, Horsley adopted transcranial approach. The first pituitary adenectomy in the world was completed. Transsphenoidal Schloffe was first established in 18th century. However, due to poor lighting and surgical instruments at that time, the tumor was not well exposed during the operation, the hemostasis was difficult, and there were more complications after the operation. In 1967, Hardy first applied it to transsphenoidal pituitary adenoma resection, with its advantages of magnification and good illumination. The transsphenoidal pituitary adenectomy has the advantages of high resection rate, small trauma, light postoperative reaction, less complications, quick recovery, short hospitalization period, and so on. At present, it is more widely used than transcranial pituitary tumor resection. However, some tumors that develop to suprasellar and parasellar tumors still need to be resected through transcranial surgery. Postoperative complications of pituitary adenoma include: intraSellar hemorrhage, epistaxis, cerebrospinal fluid leakage, intracranial infection. Diabetes insipidus, hypophysis, ophthalmoplegia, Perforation of nasal septum, etc. Diabetes insipidus is one of the most common complications after pituitary adenoma. Objective to summarize the medical records of 120 patients undergoing pituitary adenectomy in the second affiliated Hospital of Dalian Medical University from 2009 to 2017. To analyze the relationship between diabetes insipidus and age, sex, tumor size, tumor endocrine function, tumor invasion, tumor growth direction (whether the tumor breaks through the saddle septum, the operation method and the degree of tumor excision, etc.). To explore the pathogenesis, diagnosis and treatment of diabetes insipidus after pituitary adenoma. Methods the statistical analysis was carried out by SPSS19.0 software, the measurement data were analyzed by t test, the count data by X2 test, and the single factor analysis was carried out. The correlation between different factors and diabetes insipidus after pituitary adenoma operation was analyzed. The multivariate Logistic analysis showed that there were significant differences when the single factor analysis was statistically different in patients with pituitary adenoma surgery (P < 0. 05). There were 37 cases of diabetes insipidus after operation, the incidence rate of diabetes insipidus was 30.8. The results of statistical analysis showed that tumor size was the independent influencing factor of postoperative diabetes insipidus. Tumor growth pattern was the independent influencing factor of postoperative diabetes insipidus. Macroadenoma and macroadenoma is a adenoma. Pituitary tumors invading through the Sellar septum are more prone to urinary collapse than those without Sellar septum. The occurrence of diabetes insipidus is associated with age, sex, type of endocrine function, invasiveness of tumor, age, sex, type of endocrine function, invasiveness of tumor. Conclusion 1. The incidence of diabetes insipidus after pituitary adenoma surgery is related to tumor size, tumor growth direction (breakthrough of Sellar septum), but to age, sex, type of endocrine function of tumor, invasion of tumor. 2. The incidence of large adenoma was adenoma. The pituitary tumor invading through the Sellar septum was more likely to develop diabetes insipidus than those without Sellar septum. 2. During the operation, attention should be paid to the protection of hypothalamus and pituitary stalk. The diagnosis and treatment of pituitary posterior lobe tissue and its blood supply are the key to prevent and cure postoperative diabetes insipidus.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.4

【参考文献】