垂体泌乳素腺瘤经鼻神经内镜手术疗效分析  

Analysis of the efficacy of transnasal endoscopic surgery for pituitary prolactinomas

作　　者：张源 陈勇 郑新 张晓青 杨辉 李松 Zhang Yuan;Chen Yong;Zheng Xin;Zhang Xiaoqing;Yang Hui;Li Song(Department of Neurosurgery,Xinqiao Hospital,Army Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学新桥医院神经外科,重庆400037

出　　处：《中国微侵袭神经外科杂志》2024年第10期572-578,共7页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的 探讨经鼻神经内镜手术治疗垂体泌乳素(prolactin,PRL)腺瘤患者的临床疗效。方法 回顾性分析47例垂体PRL腺瘤患者临床资料,均接受经鼻神经内镜手术。所有患者至少随访6个月,对比不同肿瘤特征患者的临床疗效差异。结果 本组患者女29例(61.7%),男18例(38.3%),中位年龄31岁,术前肿瘤中位直径1.80cm。Knosp分级0级13例(27.66%),1级12例(25.53%),2级7例(14.89%),3级7例(14.89%),4级8例(17.02%)。术前服用溴隐亭28例,其中多巴胺激动剂耐药患者18例(64.3%,18/28)。术后PRL完全缓解21例(44.7%);术后感染3例,垂体功能低下4例,脑脊液漏2例,死亡2例。进一步亚组分析发现,不同肿瘤直径(0~2cm组25例、2~3cm组11例、>3cm组11例)影像学全切率分别为96%、63.4%、0%,内分泌缓解率分别为76%、18.18%、0%。0~2cm组内分泌缓解率显著高于其他两组(P<0.001),且无术后感染、脑脊液漏、垂体功能减退等并发症。根据肿瘤是否侵袭海绵窦,分为非侵袭组(32例)及侵袭组(15例),发现非侵袭组影像学全切率(84.37%)较侵袭组(26.67%)显著升高(P<0.001),非侵袭组内分泌缓解率(62.5%)较侵袭组(6.67%)显著升高(P<0.001),非侵袭组手术时间和术中出血量显著减少(P<0.05)。联合肿瘤直径与侵袭性分析表明:非侵袭性0~2cm组内分泌缓解率显著高于2~3cm组(P=0.009),两组在手术时间、术中出血量、影像全切率无显著差异。进一步对比术前口服溴隐亭对经鼻神经内镜手术治疗的疗效表明:在非侵袭性0~2cm组患者中,术前服药组内分泌缓解率(73.33%)低于未口服药物组(88.89%)、术中出血量增多(P=0.016)。结论 对于肿瘤直径小于2cm的非侵袭性PRL腺瘤,经鼻神经内镜手术具有满意手术疗效,且无不良手术并发症。经鼻神经内镜手术对于该类型PRL腺瘤有望成为替代多巴胺激动剂的一线治疗备选手段。Objective To investigate the clinical efficacy of transnasal endoscopic surgery for the treatment of patients with pituitary prolactinomas.Methods The clinical data of 47 patients with prolactinomas were analyzed retrospectively,and all of them received endoscopic transnasal surgery.All the patients were followed up for at least 6 months to compare the differences in surgical efficacy based on different tumor characteristics.Results Among the patients,there were 29 females(61.7%)and 18 males(38.3%),with a median age of 31 years and a median preoperative tumor diameter of 1.80 cm.According to the Knosp grade,there were 13 cases(27.66%)of grade 0,12 cases(25.53%)of grade 1,7 cases(14.89%)of grade 2,7 cases(14.89%)of grade 3,and 8 cases(17.02%)of grade 4.Preoperatively bromocriptine was taken in 28 cases,including 18 dopamine agonist-resistant patients(64.3%,18/28).The complete postoperative prolactin remission was 21 cases(44.7%).Postoperative complications included 3 cases of infection,4 cases of pituitary insufficiency and 2 cases of cerebrospinal fluid leak,and 2 deaths.Further subgroup analysis revealed that the imaging-confirmed total resection rates of different diameter tumors(0-2 cm group:25 cases,2-3 cm group 11 cases,>3cm group 11 cases)were 96%,63.4%,0%,and the endocrine remission rates were 76%,18.18%,and 0%,respectively.The endocrine remission rates in the 0-2cm group were significantly higher than those in the other two groups(P<0.001),and there were no post-operative infections,cerebrospinal fluid leaks,or pituitary function deficits.Based on whether the tumor invaded the cavernous sinus,the patients were divided into a non-invasive group(32 cases)and an invasive group(15 cases).The imaging-confirmed total resection rate was significantly higher in the non-invasive group(84.37%)than in the invasive group(26.67%)(P<0.001),and the endocrine remission rate was also significantly higher in the non-invasive group(62.5%)than in the invasive group(6.67%)(P<0.001).Additionally,the surgical duration and intra

关 键 词：泌乳素瘤 经鼻神经内镜 非侵袭 肿瘤体积 疗效 

分 类 号：R736.4[医药卫生—肿瘤]