DTI对垂体瘤所致前视路病变手术前后视觉功能的评估价值

发布时间：2019-03-26 14:41

【摘要】：[目的]以PVEP检查为指导,通过DTI对垂体大腺瘤所致视路病变手术前、后不同时期的对比研究,探讨获得的术后视力改善的患者术前的视辐射FA值下降区间能否用于评估患者的预后,为临床工作提供指导。[方法]对2015年3月-2016年9月间昆明医科大学第四附属医院收入的30例垂体大腺瘤患者分别在手术前、手术后1周、手术后3月行PVEP检查和DTI检查。以PVEP为标准,判断患者术后1周、术后3个月视力情况有无改善,并分析DTI参数与PVEP参数之间的相关性。确定手术后视力改善组,回顾这些患者手术前双侧视辐射FA值,建立术后视力改善组术前组。比较术后视力改善组术前组与对照组的差异性,建立术后视觉功能可改善的双侧视辐射FA下降值阈值区间。[结果]PVEP检查提示:术后1周视力改善者共计0例,术后3个月视力改善者共计18例。(1)术前患者组与术后1周患者组相比双眼P100波振幅值无统计学意义;(2)术前患者组与术后1周患者组相比双侧视辐射FA值无统计学意义;(3)术前患者组、术后1周患者组双眼P100波振幅值与双侧视辐射FA值呈明显正相关(r值分别为0.984、0.880、0.869、0.860,P值均0.01);(4)术后3月,术后视力改善组术前组与术后视力改善组相比双眼P100波振幅值具有明显差异(P＜0.01);(5)术后3月,术后视力改善组术前组与术后视力改善组相比双侧视辐射FA值具有明显差异(P＜0.01);(6)术后视力改善组术前组、术后视力改善组双眼P100波振幅值与双侧视辐射FA值呈明显正相关(r值分别为0.839、0.923、0.945、0.901,P值均0.01);(7)术后视力改善组术前组与对照组相比双侧视辐射FA值具有明显差异(P＜0.01);术后视力改善组术前组与对照组相比,双侧视辐射FA值下降约(0.087±0.014)×10-3mm2/s。[结论](1)垂体大腺瘤患者手术后1周,患者视力情况无明显改善,提示临床评价垂体大腺瘤手术效果及预后情况在此期间无明显意义;(2)垂体大腺瘤患者手术后3个月,患者视力情况明显改善,提示临床评价垂体大腺瘤手术效果及预后情况可在此期间进行;(3)垂体大腺瘤患者双眼PVEP检查与双侧视辐射DTI检查在评价视觉传导通路损伤程度、恢复程度方面具有高度正相关性,因此DTI检查参数FA值的变化情况可作为评价垂体大腺瘤所致视路损伤程度及评估手术治疗效果的有效手段;(4)垂体大腺瘤患者术前双侧视辐射FA值下降程度与后期手术治疗效果及预后情况密切相关,患者手术前双侧视辐射处FA值下降程度≤(0.087±0.014)X10-3mm2/s提示患者预后情况良好,视觉功能会有不同程度的改善。
[Abstract]:[objective] to compare the preoperative and post-operative visual pathway lesions caused by pituitary macroadenomas by DTI under the guidance of PVEP. Objective: to explore whether the decrease interval of FA value before operation in patients with improved visual acuity can be used to evaluate the prognosis of patients and to provide guidance for clinical work. [methods] 30 patients with pituitary macroadenoma admitted to the fourth affiliated Hospital of Kunming Medical University from March 2015 to September 2016 were examined by PVEP and DTI before surgery, 1 week after operation and 3 months after operation. According to the standard of PVEP, the visual acuity of the patients was evaluated 1 week and 3 months after operation, and the correlation between DTI parameters and PVEP parameters was analyzed. To determine the postoperative visual acuity improvement group, to review the FA value of bilateral visual acuity before operation, and to establish the preoperative group of postoperative visual acuity improvement group. To compare the difference between the preoperative group and the control group in the postoperative visual acuity improvement group and to establish the threshold range of FA reduction of bilateral visual radiation which can improve the visual function after operation. [results] PVEP showed that visual acuity improved in 0 cases at 1 week after operation and 18 cases in 3 months after operation. (1) there was no significant difference in the amplitude of P100 wave between the pre-operation group and the postoperative 1-week group. (2) there was no significant difference in FA value of bilateral visual radiation between the pre-operation group and the postoperative one-week group. (3) in pre-operation group and one week after operation, the amplitude of P100 wave was positively correlated with FA value of bilateral visual radiation (r = 0.984, 0.880, 0.869, 0.860, P = 0.01). (4) there was a significant difference in amplitude of P100 wave between preoperative group and postoperative visual acuity improvement group 3 months after operation (P < 0.01). (5) there was a significant difference in FA value of bilateral visual radiation between the preoperative group and the postoperative visual acuity improvement group 3 months after operation (P < 0.01). (6) there was a significant positive correlation between the amplitude of P100 wave and FA value of bilateral visual radiation in preoperative and postoperative visual acuity improvement groups (r = 0.839, 0.923, 0.945, 0.901, P = 0.01). (7) there was significant difference in FA value of bilateral visual radiation between preoperative group and control group (P < 0.01). Compared with the control group, the FA value of bilateral visual radiation decreased by (0.087 卤0.014) 脳 10 ~ (3) mm ~ (2) vs (0.087 卤0.014) 脳 10 ~ (3) mm ~ (2). [conclusion] (1) one week after surgery, the visual acuity of patients with pituitary macroadenoma did not improve significantly, suggesting that the clinical evaluation of surgical effect and prognosis of pituitary macroadenoma had no significant significance during this period. (2) the visual acuity of patients with pituitary macroadenomas improved significantly 3 months after surgery, suggesting that the clinical evaluation of surgical effects and prognosis of pituitary macroadenomas could be carried out during this period. (3) Binocular PVEP examination and bilateral visual radiation DTI examination had a high positive correlation in evaluating the degree of visual conduction pathway injury and recovery in patients with pituitary macroadenoma. Therefore, the change of FA value of DTI can be used as an effective method to evaluate the degree of visual pathway injury caused by pituitary macroadenoma and evaluate the effect of surgical treatment. (4) the decrease of FA value of bilateral visual radiation in patients with pituitary macroadenoma was closely related to the outcome of surgical treatment and prognosis. The decrease of FA value in bilateral visual radiation before operation was less than (0.087 卤0.014) X10-3mm2/s, which indicated that the prognosis of the patients was good, and the visual function could be improved to some extent.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R736.4

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