【摘要】：[目的]以PVEP檢查為指導(dǎo),通過(guò)DTI對(duì)垂體大腺瘤所致視路病變手術(shù)前、后不同時(shí)期的對(duì)比研究,探討獲得的術(shù)后視力改善的患者術(shù)前的視輻射FA值下降區(qū)間能否用于評(píng)估患者的預(yù)后,為臨床工作提供指導(dǎo)。[方法]對(duì)2015年3月-2016年9月間昆明醫(yī)科大學(xué)第四附屬醫(yī)院收入的30例垂體大腺瘤患者分別在手術(shù)前、手術(shù)后1周、手術(shù)后3月行PVEP檢查和DTI檢查。以PVEP為標(biāo)準(zhǔn),判斷患者術(shù)后1周、術(shù)后3個(gè)月視力情況有無(wú)改善,并分析DTI參數(shù)與PVEP參數(shù)之間的相關(guān)性。確定手術(shù)后視力改善組,回顧這些患者手術(shù)前雙側(cè)視輻射FA值,建立術(shù)后視力改善組術(shù)前組。比較術(shù)后視力改善組術(shù)前組與對(duì)照組的差異性,建立術(shù)后視覺(jué)功能可改善的雙側(cè)視輻射FA下降值閾值區(qū)間。[結(jié)果]PVEP檢查提示:術(shù)后1周視力改善者共計(jì)0例,術(shù)后3個(gè)月視力改善者共計(jì)18例。(1)術(shù)前患者組與術(shù)后1周患者組相比雙眼P100波振幅值無(wú)統(tǒng)計(jì)學(xué)意義;(2)術(shù)前患者組與術(shù)后1周患者組相比雙側(cè)視輻射FA值無(wú)統(tǒng)計(jì)學(xué)意義;(3)術(shù)前患者組、術(shù)后1周患者組雙眼P100波振幅值與雙側(cè)視輻射FA值呈明顯正相關(guān)(r值分別為0.984、0.880、0.869、0.860,P值均0.01);(4)術(shù)后3月,術(shù)后視力改善組術(shù)前組與術(shù)后視力改善組相比雙眼P100波振幅值具有明顯差異(P＜0.01);(5)術(shù)后3月,術(shù)后視力改善組術(shù)前組與術(shù)后視力改善組相比雙側(cè)視輻射FA值具有明顯差異(P＜0.01);(6)術(shù)后視力改善組術(shù)前組、術(shù)后視力改善組雙眼P100波振幅值與雙側(cè)視輻射FA值呈明顯正相關(guān)(r值分別為0.839、0.923、0.945、0.901,P值均0.01);(7)術(shù)后視力改善組術(shù)前組與對(duì)照組相比雙側(cè)視輻射FA值具有明顯差異(P＜0.01);術(shù)后視力改善組術(shù)前組與對(duì)照組相比,雙側(cè)視輻射FA值下降約(0.087±0.014)×10-3mm2/s。[結(jié)論](1)垂體大腺瘤患者手術(shù)后1周,患者視力情況無(wú)明顯改善,提示臨床評(píng)價(jià)垂體大腺瘤手術(shù)效果及預(yù)后情況在此期間無(wú)明顯意義;(2)垂體大腺瘤患者手術(shù)后3個(gè)月,患者視力情況明顯改善,提示臨床評(píng)價(jià)垂體大腺瘤手術(shù)效果及預(yù)后情況可在此期間進(jìn)行;(3)垂體大腺瘤患者雙眼PVEP檢查與雙側(cè)視輻射DTI檢查在評(píng)價(jià)視覺(jué)傳導(dǎo)通路損傷程度、恢復(fù)程度方面具有高度正相關(guān)性,因此DTI檢查參數(shù)FA值的變化情況可作為評(píng)價(jià)垂體大腺瘤所致視路損傷程度及評(píng)估手術(shù)治療效果的有效手段;(4)垂體大腺瘤患者術(shù)前雙側(cè)視輻射FA值下降程度與后期手術(shù)治療效果及預(yù)后情況密切相關(guān),患者手術(shù)前雙側(cè)視輻射處FA值下降程度≤(0.087±0.014)X10-3mm2/s提示患者預(yù)后情況良好,視覺(jué)功能會(huì)有不同程度的改善。
[Abstract]:[objective] to compare the preoperative and post-operative visual pathway lesions caused by pituitary macroadenomas by DTI under the guidance of PVEP. Objective: to explore whether the decrease interval of FA value before operation in patients with improved visual acuity can be used to evaluate the prognosis of patients and to provide guidance for clinical work. [methods] 30 patients with pituitary macroadenoma admitted to the fourth affiliated Hospital of Kunming Medical University from March 2015 to September 2016 were examined by PVEP and DTI before surgery, 1 week after operation and 3 months after operation. According to the standard of PVEP, the visual acuity of the patients was evaluated 1 week and 3 months after operation, and the correlation between DTI parameters and PVEP parameters was analyzed. To determine the postoperative visual acuity improvement group, to review the FA value of bilateral visual acuity before operation, and to establish the preoperative group of postoperative visual acuity improvement group. To compare the difference between the preoperative group and the control group in the postoperative visual acuity improvement group and to establish the threshold range of FA reduction of bilateral visual radiation which can improve the visual function after operation. [results] PVEP showed that visual acuity improved in 0 cases at 1 week after operation and 18 cases in 3 months after operation. (1) there was no significant difference in the amplitude of P100 wave between the pre-operation group and the postoperative 1-week group. (2) there was no significant difference in FA value of bilateral visual radiation between the pre-operation group and the postoperative one-week group. (3) in pre-operation group and one week after operation, the amplitude of P100 wave was positively correlated with FA value of bilateral visual radiation (r = 0.984, 0.880, 0.869, 0.860, P = 0.01). (4) there was a significant difference in amplitude of P100 wave between preoperative group and postoperative visual acuity improvement group 3 months after operation (P < 0.01). (5) there was a significant difference in FA value of bilateral visual radiation between the preoperative group and the postoperative visual acuity improvement group 3 months after operation (P < 0.01). (6) there was a significant positive correlation between the amplitude of P100 wave and FA value of bilateral visual radiation in preoperative and postoperative visual acuity improvement groups (r = 0.839, 0.923, 0.945, 0.901, P = 0.01). (7) there was significant difference in FA value of bilateral visual radiation between preoperative group and control group (P < 0.01). Compared with the control group, the FA value of bilateral visual radiation decreased by (0.087 鹵0.014) 脳 10 ~ (3) mm ~ (2) vs (0.087 鹵0.014) 脳 10 ~ (3) mm ~ (2). [conclusion] (1) one week after surgery, the visual acuity of patients with pituitary macroadenoma did not improve significantly, suggesting that the clinical evaluation of surgical effect and prognosis of pituitary macroadenoma had no significant significance during this period. (2) the visual acuity of patients with pituitary macroadenomas improved significantly 3 months after surgery, suggesting that the clinical evaluation of surgical effects and prognosis of pituitary macroadenomas could be carried out during this period. (3) Binocular PVEP examination and bilateral visual radiation DTI examination had a high positive correlation in evaluating the degree of visual conduction pathway injury and recovery in patients with pituitary macroadenoma. Therefore, the change of FA value of DTI can be used as an effective method to evaluate the degree of visual pathway injury caused by pituitary macroadenoma and evaluate the effect of surgical treatment. (4) the decrease of FA value of bilateral visual radiation in patients with pituitary macroadenoma was closely related to the outcome of surgical treatment and prognosis. The decrease of FA value in bilateral visual radiation before operation was less than (0.087 鹵0.014) X10-3mm2/s, which indicated that the prognosis of the patients was good, and the visual function could be improved to some extent.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.2;R736.4

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