内镜下经鼻蝶入路手术治疗垂体大腺瘤的疗效及其影响因素的分析

发布时间：2018-08-19 14:55

【摘要】：目的:分析内镜下经鼻蝶入路手术治疗垂体大腺瘤的有效率,探讨哪些因素对其疗效具有影响,并探索各个影响因素的重要程度,为今后采用内镜下经鼻蝶入路手术治疗垂体大腺瘤提供更多的理论支持、以期获得更好的预后。方法:本研究收集2012年3月至2015年5月在山西晋煤集团总医院行内镜指导下经鼻蝶入路手术切除垂体瘤,且术后病理报告为垂体腺瘤、肿瘤直径在10-30mm之间的109名患者临床资料。术前进行了详细的影像学检查、垂体内分泌检查、和视力视野检查,术后随访7~24个月,手术疗效依据激素水平和临床症状改善情况分为治愈、好转和无效,治愈和好转合计为有效。本研究分析了内镜指导下经鼻蝶入路手术治疗垂体大腺瘤的有效率,以及性别、肿瘤是否为复发、肿瘤直径、肿瘤质地、术前激素水平(催乳素和生长激素)等因素对手术疗效的影响。结果:(1)研究对象基本特征及随访情况:在109名研究对象中,男性63例,女性46例;年龄24~75岁,平均49.9±8.1岁。56例行肿瘤全切除,53例肿瘤部分切除,手术全切率为51.4%。本研究治愈患者41例,好转58例,无效10例,治愈或好转均为有效,有效率为90.8%。手术有效的患者在随访期间复发9例,其中肿瘤增大且症状加重3例,肿瘤增大且激素水平增高6例。(2)手术疗效及其影响因素:采用?2检验分析性别、肿瘤是否为复发、肿瘤直径、肿瘤质地、术前激素水平(泌乳素和生长激素)对手术疗效的影响。结果表明:肿瘤初发患者的疗效较复发患者好(P=0.006);肿瘤直径2cm组的手术有效率高于直径≥2cm组(P=0.041);肿瘤质地硬的有效率最低、质地中等次之、质地软的手术有效率最高(P=0.009)。本研究进一步采用Logistic多因素分析,分析哪些因素对手术有效率具有独立的影响,结果显示,肿瘤复发、肿瘤直径≥2cm、肿瘤质地硬是手术疗效差的独立影响因素,P0.05。结论:(1)本研究采用内镜下经鼻蝶入路手术治疗垂体大腺瘤的有效率为90.8%。(2)研究发现垂体腺瘤复发患者的手术有效率低于初发患者,肿瘤直径≥2cm的手术有效率低于直径2cm者,肿瘤质地硬的有效率最低、质地中等次之、质地软的手术有效率最高。(3)肿瘤复发、肿瘤直径≥2cm、肿瘤质地硬是内镜下经鼻蝶入路手术治疗垂体大腺瘤疗效差的独立影响因素。
[Abstract]:Objective: to analyze the effective rate of endoscopic transsphenoidal approach in the treatment of pituitary macroadenoma, and to explore which factors have influence on the curative effect, and to explore the importance of each influencing factor. To provide more theoretical support for endoscopic transsphenoidal surgery in the treatment of pituitary macroadenoma, in order to obtain a better prognosis. Methods: from March 2012 to May 2015, we collected the clinical data of 109 patients with pituitary adenoma and tumor diameter between 10-30mm and transsphenoidal approach under the guidance of endoscopy in Shanxi Jinmei Group General Hospital from March 2012 to May 2015. Detailed imaging examination, pituitary endocrine examination and visual field examination were performed before operation. The postoperative follow-up was 7 ~ 24 months. The curative effect was divided into cured, improved and ineffective according to the hormone level and the improvement of clinical symptoms. The combination of cure and improvement is effective. This study analyzed the effective rate of endoscopic transsphenoidal approach for the treatment of pituitary macroadenomas, as well as their sex, tumor recurrence, tumor diameter and tumor texture. The effect of factors such as prolactin and growth hormone on the outcome of surgery. Results: (1) the basic characteristics and follow-up: among 109 subjects, 63 cases were males and 46 cases were females, and the age was 24 ~ 75 years (mean 49.9 卤8.1 years). 53 cases had total tumor resection. The total resection rate was 51.4%. In this study, 41 cases were cured, 58 cases were improved, 10 cases were ineffective. The effective rate was 90.8%. There were 9 cases of recurrence during the follow-up period, including 3 cases of tumor enlargement and aggravated symptoms, 6 cases of tumor enlargement and increase of hormone level. (2) Surgical efficacy and its influencing factors: the sex of tumor was analyzed by the second test, and whether the tumor was recurrence or not. Effect of tumor diameter, tumor texture and preoperative hormone levels (prolactin and growth hormone) on surgical outcome. The results showed that the curative effect of primary tumor patients was better than that of recurrent patients (P0. 006), the effective rate of tumor diameter 2cm group was higher than that of diameter 鈮，

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