神经内镜经蝶手术治疗垂体瘤的疗效及预后影响因素分析  

Curative Effect of Neuroendoscopic Transsphenoidal Surgery for Pituitary Tumors and Factors Influencing the Prognosis

作　　者：周霞 杨前美 李雨倩 周良学[2] ZHOU Xia;YANG Qianmei;LI Yuqian(West China Shangjin Branch Hospital,Sichuan University,Chengdu,610730)

机构地区：[1]四川大学华西上锦分院,610730 [2]四川大学华西医院,610041

出　　处：《实用癌症杂志》2020年第9期1527-1530,1538,共5页The Practical Journal of Cancer

摘　　要：目的探究神经内镜经蝶手术治疗垂体瘤的疗效及预后的影响因素分析。方法回顾性分析行神经内镜经蝶手术治疗的101例初诊垂体瘤患者的临床资料,评价患者病灶切除效果、临床治疗效果,随访观察术后复发情况并分析其影响因素。结果入组患者垂体瘤完全切除、近全切除、次全切除、部分切除率分别为62.38%、13.86%、16.83%、6.93%;Knosp 3、4级患者完全切除率显著低于Knosp 0、1、2级垂体瘤(P<0.05);泌乳素腺瘤、生长激素腺瘤、促肾上腺皮质激素腺瘤及多分泌腺瘤临床治愈率分别为50.00%、83.33%、100.00%、83.33%;无功能型腺瘤术后症状改善率为80.56%;入组患者随访期间复发者22例(21.78%),Logistic多因素分析示:肿瘤直径≥3 cm、Knosp 3~4级、未完全切除是垂体瘤术后复发的独立危险因素(P<0.05),有辅助治疗是术后复发的保护因素(P<0.05)。结论神经内镜鼻蝶入路垂体瘤切除术对垂体瘤切除效果及治疗效果较好,但仍存在术后复发的风险,术前宜进行病灶的综合评估,对肿瘤直径较大、侵袭性较高的患者可采用手术及辅助治疗相结合的方式提高治疗效果。Objective To investigate the curative effect of neuroendoscopic transsphenoidal surgery for pituitary tumors and factors influencing the prognosis.Methods The clinical data of 101 patients with newly diagnosed pituitary tumors were retrospectively analyzed.The effect of resection and clinical treatment effects were evaluated.Postoperative recurrence was observed through follow-up to analyze the influencing factors.Results The total resection rate,proximal subtotal resection rate,subtotal resection rate and partial resection rate of pituitary tumors were 62.38%,13.86%,16.83%and 6.93%,respectively.The complete resection rates of Knosp 3 and 4 pituitary tumors were significantly lower than those of Knosp 0,1 and 2 pituitary tumors(P<0.05).Clinical cure rates of prolactinoma,growth hormone-secreting pituitary adenoma,adrenocorticotropic hormone adenoma and multi-secretory gland adenoma were 50.00%,83.33%,100.00%and 83.33%,respectively.The symptom relief rate of nonfunctioning adenoma after surgery was 80.56%.There were 22 cases(21.78%)with recurrence during the follow-up period.Multivariate logistic analysis showed that the tumor diameter of or longer than 3cm,Knosp grade 3~4 and the incomplete resection were independent risk factors for recurrence of pituitary tumors(P<0.05),while adjuvant therapy was a protective factor(P<0.05).Conclusion The resection effects and therapeutic effects of neuroendoscopic transsphenoidal surgery are good for pituitary tumors.However,there is still a risk of recurrence after surgery.It is advisable to conduct a comprehensive evaluation of the lesion before surgery.For tumors with larger diameter and high invasion,surgery combined with adjuvant therapy can be adopted to improve the treatment effects.

关 键 词：神经内镜 垂体瘤 鼻蝶入路 术后并发症 复发 

分 类 号：R739.41[医药卫生—肿瘤]