發(fā)布時(shí)間：2018-01-17 12:34

  本文關(guān)鍵詞：經(jīng)鼻垂體腺瘤切除術(shù)后復(fù)發(fā)相關(guān)因素的研究　出處：《天津醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 垂體腺瘤 經(jīng)鼻入路 復(fù)發(fā) Logistis 多元素回歸分析 卡方檢驗(yàn)

【摘要】：目的:垂體腺瘤為顱內(nèi)最常見的鞍區(qū)占位性病變,近年來,經(jīng)鼻垂體腺瘤切除術(shù)已經(jīng)廣泛應(yīng)用于垂體腺瘤的治療當(dāng)中,但因其有著比較高的復(fù)發(fā)率,為臨床醫(yī)生及患者帶來很多困擾。本研究試圖通過分析影響經(jīng)鼻垂體腺瘤切除術(shù)后復(fù)發(fā)的相關(guān)因素,找尋更有效的治療方法,降低術(shù)后復(fù)發(fā)率,為垂體腺瘤患者提供更有效的治療方案,從而提高臨床治愈率,減輕垂體腺瘤患者的痛苦。方法:回顧性分析自2004年1月-2011年1月于天津市環(huán)湖醫(yī)院行經(jīng)鼻垂體腺瘤切除術(shù)的102例患者,通過病例采集記錄所有患者的臨床特征,包括:性別、發(fā)病年齡、腫瘤有無功能性、腫瘤最大直徑、臨床癥狀、腫瘤有無侵襲性、腫瘤是否殘留、是否結(jié)合術(shù)后輔助治療、是否合并垂體卒中及手術(shù)方式(顯微鏡下或內(nèi)鏡下經(jīng)鼻蝶垂體腺瘤切除術(shù))等,記錄患者定期復(fù)查時(shí)的隨訪結(jié)果并計(jì)算復(fù)發(fā)率,采用Logistic逐步回歸分析法,得出影響經(jīng)鼻垂體腺瘤切除術(shù)后復(fù)發(fā)的相關(guān)因素,并分析其可能的因素�？ǚ綑z驗(yàn)分析殘留在海綿竇內(nèi)外的腫瘤組織的復(fù)發(fā)率是否存在差異。Fisher確切概率法分析功能性垂體腺瘤中各個臨床癥狀與術(shù)后復(fù)發(fā)的關(guān)系。結(jié)果:4-60個月(平均隨訪時(shí)間38.4個月)的隨訪過程中,102例患者有21例(20.5%)復(fù)發(fā),復(fù)發(fā)時(shí)間最短為術(shù)后10個月,最長為術(shù)后5年,平均復(fù)發(fā)時(shí)間為術(shù)后48.5個月。通過對性別、發(fā)病年齡、腫瘤有無功能性、腫瘤最大直徑、腫瘤有無侵襲性、腫瘤是否殘留、是否結(jié)合術(shù)后輔助治療、腫瘤是否合并卒中及手術(shù)方式等臨床特征進(jìn)行Logistic逐步回歸分析可得出,影響經(jīng)鼻垂體腺瘤切除術(shù)后復(fù)發(fā)的因素包括:腫瘤殘留(p=0.001)、腫瘤侵襲性(p=0.033)、腫瘤合并垂體卒中(p=0.029)及術(shù)后結(jié)合輔助治療(p=0.023),而性別、發(fā)病年齡、腫瘤最大直徑、腫瘤有無功能性及手術(shù)方式與經(jīng)鼻垂體腺瘤切除術(shù)后復(fù)發(fā)無明顯相關(guān)性(p值均0.05)。對術(shù)后腫瘤有殘留的病例進(jìn)一步分析發(fā)現(xiàn)腫瘤殘留位置(海綿竇內(nèi)或外)與術(shù)后復(fù)發(fā)無明顯相關(guān)性(p=0.288)。雖然腫瘤有無功能性對腫瘤復(fù)發(fā)無明顯影響,但功能性垂體腺瘤中伴有月經(jīng)失調(diào)臨床癥狀的復(fù)發(fā)率明顯高于伴有其他癥狀者,需嚴(yán)格進(jìn)行定期復(fù)查。腫瘤直徑越大(尤其是大于10mm),相較于體積小的腫瘤復(fù)發(fā)率高,應(yīng)視為腫瘤復(fù)發(fā)的危險(xiǎn)因素。結(jié)論:本研究通過分析表明,垂體腺瘤伴有卒中、腫瘤具有侵襲性及術(shù)后腫瘤殘留增加術(shù)后復(fù)發(fā)發(fā)生的風(fēng)險(xiǎn),術(shù)后結(jié)合輔助治療可以使術(shù)后復(fù)發(fā)率降低,性別、發(fā)病年齡、腫瘤最大直徑、腫瘤有無功能性及手術(shù)方式與經(jīng)鼻垂體腺瘤切除術(shù)后復(fù)發(fā)無明顯相關(guān)性。根據(jù)本研究得出的結(jié)論,可以幫助臨床醫(yī)師總結(jié)患者術(shù)前情況,并結(jié)合臨床癥狀綜合分析病情,制定有效的治療方法,提高經(jīng)鼻垂體腺瘤切除術(shù)的整體治愈率。
[Abstract]:Objective: pituitary adenoma is the most common intracranial lesions in the Sellar area. In recent years, transnasal pituitary adenomectomy has been widely used in the treatment of pituitary adenomas, but it has a high recurrence rate. This study attempts to find a more effective treatment to reduce the postoperative recurrence rate by analyzing the related factors affecting the recurrence of pituitary adenoma after transnasal pituitary adenoma resection. To provide a more effective treatment for patients with pituitary adenoma, so as to improve the clinical cure rate. Methods: from January 2004 to January 2011, 102 patients with pituitary adenoma were treated with transnasal pituitary adenectomy at Tianjin Huanghu Hospital. The clinical features of all patients were recorded by case collection, including: sex, age of onset, function of tumor, maximum diameter of tumor, clinical symptoms, tumor invasiveness and residual tumor. Whether to combine with postoperative adjuvant therapy, whether to combine pituitary apoplexy and operation (microscopical or endoscopic transsphenoidal pituitary adenomectomy), to record the follow-up results and calculate the recurrence rate. Logistic stepwise regression analysis was used to determine the factors affecting the recurrence of pituitary adenomas after resection. Chi-square test was used to analyze the recurrence rate of residual tumor tissues inside and outside the cavernous sinus. Fisher exact probability method was used to analyze the clinical symptoms and postoperative outcomes of functional pituitary adenomas. The relation of recurrence. Result:. 4-60 months (. The mean follow-up time was 38.4 months. The recurrence time was 10 months, the longest was 5 years, and the average recurrence time was 48.5 months. Whether the tumor is functional, the tumor has the largest diameter, whether the tumor has invasiveness, whether the tumor remains or not, and whether it is combined with postoperative adjuvant therapy. Logistic stepwise regression analysis can be used to determine whether the tumor is associated with stroke and surgical methods. The factors influencing the recurrence of pituitary adenoma after transnasal pituitary adenoma resection were as follows: residual tumor was 0.001, tumor invasiveness was 0.033). Tumor complicated with pituitary apoplexy (p0.029) and postoperative adjuvant therapy (p0.023), sex, age of onset, maximum diameter of tumor. There was no significant correlation between tumor function and operative method and recurrence of pituitary adenoma after transnasal pituitary adenoma resection (P < 0.05). There was no significant correlation between intra and outer cavernous sinus recurrence and postoperative recurrence, although the function of the tumor had no significant effect on the recurrence of the tumor. However, the recurrence rate of functional pituitary adenomas with menstrual disorders is significantly higher than that of patients with other symptoms. The larger the tumor diameter is (especially > 10mm), the more periodic reexamination is required. Compared with the small tumor recurrence rate, it should be considered as a risk factor for tumor recurrence. Conclusion: this study shows that pituitary adenoma is associated with stroke. Tumor invasiveness and residual tumor increase the risk of recurrence after surgery, postoperative combined with adjuvant treatment can reduce the recurrence rate, sex, age of onset, tumor maximum diameter. There is no significant correlation between the tumor function and the operation method. According to the conclusion of this study, it can help clinicians to sum up the preoperative situation of patients. Combined with clinical symptoms and comprehensive analysis of the disease, an effective treatment method to improve the overall cure rate of transnasal pituitary adenoma resection.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R736.4

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