發(fā)布時間：2018-08-19 14:55

【摘要】：目的:分析內(nèi)鏡下經(jīng)鼻蝶入路手術治療垂體大腺瘤的有效率,探討哪些因素對其療效具有影響,并探索各個影響因素的重要程度,為今后采用內(nèi)鏡下經(jīng)鼻蝶入路手術治療垂體大腺瘤提供更多的理論支持、以期獲得更好的預后。方法:本研究收集2012年3月至2015年5月在山西晉煤集團總醫(yī)院行內(nèi)鏡指導下經(jīng)鼻蝶入路手術切除垂體瘤,且術后病理報告為垂體腺瘤、腫瘤直徑在10-30mm之間的109名患者臨床資料。術前進行了詳細的影像學檢查、垂體內(nèi)分泌檢查、和視力視野檢查,術后隨訪7~24個月,手術療效依據(jù)激素水平和臨床癥狀改善情況分為治愈、好轉(zhuǎn)和無效,治愈和好轉(zhuǎn)合計為有效。本研究分析了內(nèi)鏡指導下經(jīng)鼻蝶入路手術治療垂體大腺瘤的有效率,以及性別、腫瘤是否為復發(fā)、腫瘤直徑、腫瘤質(zhì)地、術前激素水平(催乳素和生長激素)等因素對手術療效的影響。結(jié)果:(1)研究對象基本特征及隨訪情況:在109名研究對象中,男性63例,女性46例;年齡24~75歲,平均49.9±8.1歲。56例行腫瘤全切除,53例腫瘤部分切除,手術全切率為51.4%。本研究治愈患者41例,好轉(zhuǎn)58例,無效10例,治愈或好轉(zhuǎn)均為有效,有效率為90.8%。手術有效的患者在隨訪期間復發(fā)9例,其中腫瘤增大且癥狀加重3例,腫瘤增大且激素水平增高6例。(2)手術療效及其影響因素:采用?2檢驗分析性別、腫瘤是否為復發(fā)、腫瘤直徑、腫瘤質(zhì)地、術前激素水平(泌乳素和生長激素)對手術療效的影響。結(jié)果表明:腫瘤初發(fā)患者的療效較復發(fā)患者好(P=0.006);腫瘤直徑2cm組的手術有效率高于直徑≥2cm組(P=0.041);腫瘤質(zhì)地硬的有效率最低、質(zhì)地中等次之、質(zhì)地軟的手術有效率最高(P=0.009)。本研究進一步采用Logistic多因素分析,分析哪些因素對手術有效率具有獨立的影響,結(jié)果顯示,腫瘤復發(fā)、腫瘤直徑≥2cm、腫瘤質(zhì)地硬是手術療效差的獨立影響因素,P0.05。結(jié)論:(1)本研究采用內(nèi)鏡下經(jīng)鼻蝶入路手術治療垂體大腺瘤的有效率為90.8%。(2)研究發(fā)現(xiàn)垂體腺瘤復發(fā)患者的手術有效率低于初發(fā)患者,腫瘤直徑≥2cm的手術有效率低于直徑2cm者,腫瘤質(zhì)地硬的有效率最低、質(zhì)地中等次之、質(zhì)地軟的手術有效率最高。(3)腫瘤復發(fā)、腫瘤直徑≥2cm、腫瘤質(zhì)地硬是內(nèi)鏡下經(jīng)鼻蝶入路手術治療垂體大腺瘤療效差的獨立影響因素。
[Abstract]:Objective: to analyze the effective rate of endoscopic transsphenoidal approach in the treatment of pituitary macroadenoma, and to explore which factors have influence on the curative effect, and to explore the importance of each influencing factor. To provide more theoretical support for endoscopic transsphenoidal surgery in the treatment of pituitary macroadenoma, in order to obtain a better prognosis. Methods: from March 2012 to May 2015, we collected the clinical data of 109 patients with pituitary adenoma and tumor diameter between 10-30mm and transsphenoidal approach under the guidance of endoscopy in Shanxi Jinmei Group General Hospital from March 2012 to May 2015. Detailed imaging examination, pituitary endocrine examination and visual field examination were performed before operation. The postoperative follow-up was 7 ~ 24 months. The curative effect was divided into cured, improved and ineffective according to the hormone level and the improvement of clinical symptoms. The combination of cure and improvement is effective. This study analyzed the effective rate of endoscopic transsphenoidal approach for the treatment of pituitary macroadenomas, as well as their sex, tumor recurrence, tumor diameter and tumor texture. The effect of factors such as prolactin and growth hormone on the outcome of surgery. Results: (1) the basic characteristics and follow-up: among 109 subjects, 63 cases were males and 46 cases were females, and the age was 24 ~ 75 years (mean 49.9 鹵8.1 years). 53 cases had total tumor resection. The total resection rate was 51.4%. In this study, 41 cases were cured, 58 cases were improved, 10 cases were ineffective. The effective rate was 90.8%. There were 9 cases of recurrence during the follow-up period, including 3 cases of tumor enlargement and aggravated symptoms, 6 cases of tumor enlargement and increase of hormone level. (2) Surgical efficacy and its influencing factors: the sex of tumor was analyzed by the second test, and whether the tumor was recurrence or not. Effect of tumor diameter, tumor texture and preoperative hormone levels (prolactin and growth hormone) on surgical outcome. The results showed that the curative effect of primary tumor patients was better than that of recurrent patients (P0. 006), the effective rate of tumor diameter 2cm group was higher than that of diameter 鈮，

本文編號：2191995