神经内镜经鼻蝶窦入路垂体腺瘤切除术后尿崩症的影响因素分析  

Analysis of influencing factors of diabetes insipidus after neuroendoscopic transnasosphenoidal surgery for pituitary adenoma

作　　者：刘重友 张桐 邓李轶 姜智元 郭威才 郭同轩 王雷 刘勇 LIU Chongyou;ZHANG Tong;DENG Liyi;JIANG Zhiyuan;GUO Weicai;GUO Tongxuan;WANG Lei;LIU Yong(Department of Neurosurgery,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]徐州医科大学附属医院神经外科,221000

出　　处：《浙江医学》2024年第1期37-40,56,共5页Zhejiang Medical Journal

基　　金：国家自然基金科学项目(82002632)。

摘　　要：目的探讨神经内镜经鼻蝶窦入路垂体腺瘤切除术后尿崩症的影响因素。方法选取2021年1月至2022年6月在徐州医科大学附属医院行神经内镜经鼻蝶窦入路垂体腺瘤切除术治疗的89例患者为研究对象,术后3 d内出现尿崩症63例,为尿崩症组;未出现尿崩症26例,为非尿崩症组。比较两组患者肿瘤直径、肿瘤生长方式、肿瘤Knosp分级、MRI参数(手术前后肿瘤腔上下径变化值、手术前后垂体到鞍底距离变化值)等临床资料,采用多因素logistic回归分析患者术后发生尿崩症的影响因素。结果尿崩症组肿瘤直径>3 cm、肿瘤鞍上生长、肿瘤Knosp分级3~4级、术前视力障碍、术中脑脊液漏、术后未切除假包膜的比例以及手术前后肿瘤腔上下径变化值、手术前后垂体到鞍底距离变化值均明显高于非尿崩症组,差异均有统计学意义(均P<0.05)。手术前后肿瘤腔上下径变化值(OR=0.497)、手术前后垂体到鞍底距离变化值(OR=2.886)是患者术后发生尿崩症的独立影响因素(均P<0.05)。结论手术前后肿瘤腔上下径变化值、手术前后垂体到鞍底距离变化值是神经内镜经鼻蝶窦入路垂体腺瘤切除术后发生尿崩症的独立影响因素。Objective To explore the factors influencing diabetes insipidus(DI)after neuroendoscopic transnasosphenoidal surgery for pituitary adenoma.Methods A total of 89 patients who underwent pituitary adenoma resection by neuroendoscopic transnasosphenoidal approach from January 2021 to June 2022 at the Affiliated Hospital of Xuzhou Medical University were selected as research objects,including 63 patients in DI group where DI occurred within three days after surgery,and 26 patients in non-DI group without DI after surgery.The two groups were compared in terms of tumor diameter,mode of tumor growth,Knosp classification of the tumor,MRI parameters(the changes of cephalocaudal tumor cavity diameter and the changes of distance from pituitary to saddle bottom before and after surgery)and other clinical data.A multivariate logistic regression analysis was performed to determine the influencing factors of occurrence of DI after surgery.Results The DI group was significantly higher than the non-DI group in proportions of tumor diameter>3 cm,suprasellar growth of the tumor,levels 3-4 in Knosp classification,presence of preoperative visual impairment,and intraoperative cerebrospinal fluid leak,proportion of intraoperative non-removal of the pseudocapsule,changes of cephalocaudal tumor cavity diameter,and changes of the distance from pituitary to saddle bottom,the differences of which were statistically significant(all P<0.05).The changes of cephalocaudal tumor cavity diameter(OR=0.497)and the distance from pituitary to saddle bottom(OR=2.886)were the independent influencing factors of occurrence of DI after surgery(both P<0.05).Conclusion The changes of cephalocaudal tumor cavity diameter and the distance from pituitary to saddle bottom are factors independently influencing the occurrence of DI after neuroendoscopic transnasosphenoidal surgery for pituitary adenoma.

关 键 词：垂体腺瘤 尿崩症 神经内镜 肿瘤腔上下径 垂体到鞍底距离 

分 类 号：R736.4[医药卫生—肿瘤]