垂体催乳素细胞肿瘤手术疗效观察及术后生化缓解的影响因素分析  

Analysis of influencing factors of surgical efficacy and biochemical remission of prolactin-secreting pituitary neuroendocrine tumors

作　　者：薛亚轲[1] 李建国 杨凤东[1] 毛文斌 魏新亭[1] 翟一轩 Xue Yake;Li Jianguo;Yang Fengdong;Mao Wenbin;Wei Xinting;Zhai Yixuan(Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院神经外科,郑州450052

出　　处：《中华神经外科杂志》2025年第1期25-30,共6页Chinese Journal of Neurosurgery

基　　金：河南省重点研发与推广专项(科技攻关)(232102310172);郑州市基础研究与应用基础研究(2024ZZJCYJ033)。

摘　　要：目的探讨垂体催乳素(PRL)细胞肿瘤患者的手术疗效并分析影响术后生化缓解的因素。方法回顾性收集2020年1月至2023年12月郑州大学第一附属医院神经外科接受手术治疗的283例PRL细胞肿瘤患者的临床资料。术后1、3、6、12个月通过电话及门诊方式对患者进行临床随访,获知患者术后药物服用情况;通过实验室检查血清PRL水平;采用头颅MRI检查评估患者肿瘤切除程度及术后是否复发。根据术后血清PRL是否降至正常水平(即生化缓解)分为缓解组(196例)和未缓解组(87例),比较两组患者临床资料的差异,并将P<0.05的因素纳入多因素logistic回归分析,探讨影响术后生化缓解的因素。结果283例患者的手术均顺利完成。其中肿瘤全切除196例(69.26%),近全切除76例(26.85%),部分切除11例(3.89%)。148例(52.30%)患者术后发生并发症,包括短期并发症133例(47.00%),其中脑脊液鼻漏16例、尿崩症34例、暂时性垂体功能低下53例、颅内感染15例、视力恶化8例、鼻出血7例,经对症治疗后均缓解;长期并发症15例(5.30%),其中永久性垂体功能低下12例、嗅觉丧失3例。术后达到生化缓解196例(69.26%),未缓解87例(30.74%)。283例患者均获得临床随访,随访时间[M(Q 1,Q 3)]为11.2(5.0,17.0)个月。术后未缓解组患者中,79例口服溴隐亭后血清PRL降至正常水平,8例改口服卡麦角林后血清PRL降至正常水平。末次随访显示,所有患者的肿瘤均未见复发。缓解组与未缓解组患者的性别、年龄、术前发生肿瘤卒中、肿瘤血供的差异均无统计学意义(均P>0.05);而缓解组的术前血清PRL水平较未缓解组低,Knosp分级0~2级、微小型PRL细胞肿瘤、神经内镜经鼻入路手术、肿瘤存在假包膜、手术全切除、肿瘤质软的患者占比均较未缓解组高,差异均具有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,术前血清PRL水平(OR=1.98,95%CI:1.96~1.99,P=0.022)为Objective To analysis the influencing factors of surgical efficacy and biochemical remission of prolactin-secreting pituitary neuroendocrine tumors(PitNETs).Methods A retrospective analysis was conducted on the clinical data of 283 patients with prolactin-secreting PitNETs who underwent surgical operations at the Department of Neurosurgery,the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2023.Clinical follow-up was carried out through telephone interview and outpatient visits at 1,3,6 and 12 months after surgery to obtain information about postoperative medicine use.The prolactin level was detected by blood biochemical test,and MRI was used to evaluated the extent of resection and tumor recurrence.According to the prolactin level(biochemical remission),patients were divided into remission group(196 cases)and non-remission group(87 cases).The differences in clinical characteristics between the two groups were analyzed,and the factors with P<0.05 were included in the multivariate logistic regression analysis to explore the factors influencing postoperative biochemical remission.Results The surgeries of all 283 patients were successfully completed.Among them,196 cases(69.26%)achieved gross-total resection,76 cases(26.85%)achieved near-total resection,11 cases(3.89%)achieved partial resection.Postoperative complications occurred in 148 cases(52.30%),including 133 cases(47.00%)of short-term complications,among which there were 16 cases of cerebrospinal fluid rhinorrhea,34 cases of diabetes insipidus,53 cases of temporary hypopituitarism,15 cases of intracranial infection,8 cases of visual deterioration,and 7 cases of epistaxis.All were relieved after symptomatic treatment.Long-term complications occurred in 15 cases(5.30%),including 12 cases of permanent hypopituitarism and 3 cases of anosmia.Postoperative biochemical remission was achieved in 196 cases(69.26%),and no remission was observed in 87 cases(30.74%).All 283 patients received follow-up,and the follow-up time[M(Q 1,Q 3)]was

关 键 词：催乳素瘤 神经外科手术 自然腔道内镜手术 治疗结果 影响因素分析 

分 类 号：R73[医药卫生—肿瘤]