垂体腺瘤侵蚀颅底骨质的相关因素研究  

Analysis on correlative factors of pituitary adenoma invading skull base bone

作　　者：蒲九君 王志明[1] 周辉[1] 钟艾凌 阮伦亮 靳凯[1] 杨刚[1] 

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016

出　　处：《重庆医科大学学报》2015年第12期1537-1540,共4页Journal of Chongqing Medical University

基　　金：国家临床重点专科建设经费资助项目(编号:[2011]170);重庆市科委自然科学基金资助项目(编号:CSTC2013jcyj A10079)

摘　　要：目的:探讨影响垂体腺瘤侵蚀颅底骨质的相关因素分析。方法:收集我科2013年1月至2014年1月间227例垂体腺瘤患者的临床资料。根据术前的CT及颅底骨质三维重建分为侵蚀颅底骨质组(63例)和未侵蚀颅底骨质组(164例),并对2组资料进行回顾性对比分析,logistic回归分析影响颅底骨质侵袭的危险因素。结果:颅底骨质侵蚀组垂体腺瘤手术时间(154.02±56.67)min、术中出血量(219.84±250.57)ml、术后并发症发生率33.4%(21/63)及ki-67蛋白的阳性表达率47.4%(27/57)较未侵蚀组[(124.35±42.75)min,(128.66±116.9)ml,10.9%(18/164),26.4%(28/106)]多(P<0.05);单因素及多因素logistic回归分析发现无功能性腺瘤(OR=2.219,P=0.023)、巨大垂体腺瘤(OR=18.63,P=0.031)、Knosp分级4级(OR=6.228,P=0.007)及腺瘤质地坚韧(OR=2.915,P=0.032)是侵蚀颅底骨质的危险因素,其中无功能性垂体腺瘤是独立危险因素。结论:垂体腺瘤侵蚀颅底骨质使手术难度增加;无功能性腺瘤、巨大腺瘤、Knosp分级4级及质地坚韧是垂体腺瘤侵蚀颅底骨质的危险因素。Objective：To study the correlative factors in operation of pituitary adenoma invading the skull base bone. Methods：Clinical, imaging and pathological data of 227 patients were collected from January 2013 to January 2014 in our department of ueurosurgery. The patients were divided into two groups：the invasive bone group（63 cases） and the noninvasive bone group（164 cases） based on the CT image.All data of two groups were comparatively analyzed and the correlation with eroding bone was analyzed by logistic re- gression. Results： Time of operation, amount of bleeding, the morbidity rate of complication and the positive expression of ki-67 protein in invasive bone group were （154.02 ±56.67） min, （219.84 ± 250.57） ml,42.4%（42/99） and 47.4%（27/57） respectively,which sig- nificantly higher than those in noninvasive group[（124.35 ± 42.75） rain, （128.66± 116.9） m1,10.9%（18/164） and 26.4%（28/106）]. The risk factor of eroding the skull base bone was non-functional adenomas（OR=2.219, P=0.023）, giant adenoma（OR=18.63,P= 0.031 ）, the hard adenoma （OR=2.915,P=0.032） and the adenoma with Knosp-Steiner grade of 4 （OR =6.228,P=0.007）. The inci- dence rate（32%） of bony invasion in non-functional pituitary adenomas was significantly higher than that in functional pituitary ade- nomas. Conclusion：Bony invasion of pituitary adenoma makes the surgery more difficult, which occurs more common in non-func- tional pituitary adenoma.Non-function, giant size, tough quality and Knosp grade 4 of pituitary adenoma are the risk factors for invad- ing the bone of skull base.

关 键 词：l颅底骨质侵蚀 垂体巨大腺瘤 质地坚韧 Knosp分级 

分 类 号：R651.11[医药卫生—外科学]