神经内镜下经鼻蝶治疗不同类型垂体瘤的临床疗效分析
|
摘要
目的比较不同类型垂体瘤患者神经内镜下经鼻蝶手术治疗的临床疗效,探讨垂体瘤患者神经内镜手术的最佳适应证。方法选取2016年6月至2017年10月于徐州医科大学附属医院行神经内镜下经鼻蝶手术方式治疗的92例不同类型垂体瘤患者,通过对其术后激素水平是否正常、肿瘤是否全切进行对比评估不同类型垂体瘤患者的手术治疗效果。对患者进行追踪随访,使用健康测量量表(SF-36)评估患者生理机能(PF)、生理职能(RP)、情感职能(RE),评估不同类型垂体瘤患者的术后生活质量。结果神经内镜在治疗不同类型垂体瘤方面的临床疗效存在差异,其从高到低的治愈率依次是皮质激素腺瘤、生长激素腺瘤、泌乳素腺瘤、混合型腺瘤、无功能腺瘤,功能型垂体瘤的治愈率明显高于无功能型垂体瘤,差异具有统计学意义(P<0.05)。功能型垂体瘤患者术后6个月随访时的PF得分(76.80±8.70)分,RP得分(78.37±19.10)分,RE得分(71.60±21.54)分;术后12个月随访时PF得分(87.30±9.33)分,RP得分(78.73±15.20)分,RE得分(87.86±17.75)分,均高于无功能型垂体腺瘤患者,差异均具有统计学意(P<0.05)。结论功能型垂体瘤患者接受神经内镜手术治疗,以皮质激素腺瘤的治疗效果最好,并且可以显著提高术后患者的生活质量。
Objective To explore the best indication of neuroendoscopic surgery in patients with pituitary tumors by comparing the clinical effects of neuroendoscopic transsphenoidal surgery on patients with different types of pituitary tumors.Methods A total of 92 patients with different types of pituitary adenoma received transsphenoidal approach under neuroendoscopy in our hospital from June 2016 to October2017 were selected,the surgical results were evaluated by comparing the postoperative hormone levels were normal or not and the tumor were resected or not.The patients were followed up,the physiological function(PF),physiological function(RP),emotional functions(RE) was determined by health measurement scale(SF-36) to evaluated the quality of life of patients.Results There were differences in clinical efficacy of neuroendoscopy for the treatment of different types of pituitary adenoma,the cure rate from high to low in turn was cortical hormone adenomas,growth hormone adenomas,prolactin adenomas,mixed adenoma,non-functional adenomas,the cure rate of functional pituitary adenoma was obviously higher than that of no functional pituitary adenoma,the difference was statistically significant(P<0.05).At 6 months after surgery,SF-36 result showed that PF scores was(76.30 ± 8.68),RP scores was(78.37 ± 19.05),RE scores was(71.54 ± 21.54),and at 12 months after surgery,PF scores was(87.20 ± 9.24),RP scores was(78.66 ± 15.18) and RE scores was(87.80 ± 17.67),which were higher in patients with functional pituitary adenoma than those in patients with non-functional pituitary adenoma,the differences were significant(P<0.05).Conclusion The treatment of functional pituitary tumor by neuroendoscopic surgery,especially corticosteroid adenoma,has the best effect,and can significantly improve the quality of life of patients.
Objective To explore the best indication of neuroendoscopic surgery in patients with pituitary tumors by comparing the clinical effects of neuroendoscopic transsphenoidal surgery on patients with different types of pituitary tumors.Methods A total of 92 patients with different types of pituitary adenoma received transsphenoidal approach under neuroendoscopy in our hospital from June 2016 to October2017 were selected,the surgical results were evaluated by comparing the postoperative hormone levels were normal or not and the tumor were resected or not.The patients were followed up,the physiological function(PF),physiological function(RP),emotional functions(RE) was determined by health measurement scale(SF-36) to evaluated the quality of life of patients.Results There were differences in clinical efficacy of neuroendoscopy for the treatment of different types of pituitary adenoma,the cure rate from high to low in turn was cortical hormone adenomas,growth hormone adenomas,prolactin adenomas,mixed adenoma,non-functional adenomas,the cure rate of functional pituitary adenoma was obviously higher than that of no functional pituitary adenoma,the difference was statistically significant(P<0.05).At 6 months after surgery,SF-36 result showed that PF scores was(76.30 ± 8.68),RP scores was(78.37 ± 19.05),RE scores was(71.54 ± 21.54),and at 12 months after surgery,PF scores was(87.20 ± 9.24),RP scores was(78.66 ± 15.18) and RE scores was(87.80 ± 17.67),which were higher in patients with functional pituitary adenoma than those in patients with non-functional pituitary adenoma,the differences were significant(P<0.05).Conclusion The treatment of functional pituitary tumor by neuroendoscopic surgery,especially corticosteroid adenoma,has the best effect,and can significantly improve the quality of life of patients.
引文
[1]王忠诚.王忠诚神经外科学[M].武汉:湖北科学技术出版社,2005:620.
[2]Cappabianca P,Cavallo LM,Solari D,et al.Endoscopic endonasal surgery for pituitary adenomas[J].World Neurosurg,2014,82(6):S3-S11.doi:10.1016/j.wneu.2014.07.019.
[3]Dehdashti AR,Ganna A,Karabatsou K,et al.Pure endoscopic endonasal approach for pituitary adenomas:early surgical results in 200patients and comparison with previous microsurgical series[J].Neurosurgery,2008,62(5):1006-1015.doi:10.1227/01.neu.0000325862.83961.12.
[4]Aflorei ED,Korbonits M.Epidemiology and etiopathogenesis of pituitary adenomas[J].J Neurooncol,2014,117(3):379-394.doi:10.1007/s11060-013-1354-5.
[5]Scheithauer BW,Gaffey TA,Lloyd RV,et al.Pathobiology of pituitary adenomas and carcinomas[J].Neurosurgery,2006,59(2):341-353.
[6]Zaidi HA,Reyes KDL,Barkhoudarian G,et al.The utility of high-resolution intraoperative MRI in endoscopic transsphenoidal surgery for pituitary macroadenomas:early experience in the advanced multimodality image guided operating suite[J].Neurosurg Focus,2016,40(3):E18.doi:10.3171/2016.1.FOCUS15515.
[7]王勇,吴冲,张洪亮,等.神经内镜下切除功能性垂体瘤术后激素水平改善的效果分析[J].临床神经外科杂志,2015,17(4):265-268.doi:10.3969/j.issn.1672-7770.2015.04.007.
[8]Ogra S,Nichols AD,Stylli S,et al.Visual acuity and pattern of visual field loss at presentation in pituitary adenoma[J].J Clin Neurosci,2014,21(5):735-740.doi:10.1016/j.jocn.2014.01.005.
[9]郭振华,丁长青,史先基,等.首诊于眼科的鞍区病变53例临床与磁共振成像分析[J].广西医学,2015,37(9):1326-1327.doi:10.11675/j.issn.0253-4304.2015.09.35.
[10]耿亚东,魏新亭,薛亚珂,等.神经内镜下经鼻蝶入路切除垂体腺瘤99例[J].实用医学杂志,2017,33(24):4197-4198.doi:10.3969/j.issn.1006-5725.2017.24.045.
[11]Yano S,Hide T,Shinojima N.Efficacy and complications of endoscopic skull base surgery for giant pituitary adenomas[J].World Neurosurg,2017,99:533-542.doi:10.1016/j.wneu.2016.12.068.
[12]Nieman L,Biller B,Findling J,et al.Withdrawn:the diagnosis of Cushing's syndrome:an endocrine society clinical practice guideline[J].Eur J Endocrinol,2009,11(2):147-153.doi:10.1530/EJE-09-0695.
[13]Woodworth GF,Patel KS,Shin B,et al.Surgical outcomes using a medial-to-lateral endonasal endoscopic approach to pituitary adenomas invading the cavernous sinus[J].J Neurosurg,2014,120(5):1086-1094.doi:10.3171/2014.1.JNS131228.
[14]王勇,吴冲,张洪亮,等.神经内镜下切除功能性垂体瘤术后激素水平改善的效果分析[J].临床神经外科杂志,2015,12(4):265-268.doi:10.3969/j.issn.1672-7770.2015.04.007.
[15]郑文键,李维平,纪涛,等.神经内镜经鼻蝶入路垂体瘤切除术的临床疗效和并发症分析[J].中华神经医学杂志,2015,14(6):609-613.doi:10.3760/cma.j.issn.1671-8925.2015.06.014.
[16]Babey M,Sahli R,Vajtai I,et al.Pituitary surgery for small prolactinomas as an alternative to treatment with dopamine agonists[J].Pituitary,2011,14(3):222-230.doi:10.1007/s11102-010-0283-y.
[17]中国垂体腺瘤协作组.中国垂体催乳素腺瘤诊治共识(2014版)[J].中华医学杂志,2014,94(31):2406-2411.doi:10.3760/cma.j.issn.0376-2491.2014.31.004.
[18]Qu X,Xu G,Qu Y,et al.The pseudocapsule surrounding a pituitary adenoma and its clinical significance[J].J Neurooncol,2011,101(2):171-178.doi:10.1007/s11060-010-0247-0.
[19]张红赟,邢振义,孙来广.神经内镜与显微镜下经鼻蝶垂体瘤切除术的对比[J].中华实验外科杂志,2015,32(3):618-620.doi:10.3760/cma.j.issn.1001-9030.2015.03.062.
[20]马军辉.内分泌激素水平与垂体瘤手术远期疗效的相关性研究[J].临床研究,2015,23(5):218-219.doi:10.3969/j.issn.1004-8650.2015.05.216
[21]Guiot J,Rougerie J,Fourestier M,et al.Intracranial endoscopic explorations[J].Presse Med,1963,71:1225-1228.
[22]田新华,张俊卿,陈锷,等.显微镜与神经内镜下经单鼻孔蝶窦垂体腺瘤切除术的比较[J].中华神经外科杂志,2007,23(3):182-184.doi:10.3760/j.issn:1001-2346.2007.03.008.
[23]鲁晓杰,陈开来,王清,等.内镜和显微镜下经鼻入路鞍区的解剖学对比研究[J].中华显微外科杂志,2010,33(2):140-142.doi:10.3760/cma.j.issn.1001-2036.2010.02.019.
[24]张亚卓,邸虓.内镜神经外科学[M].人民卫生出版社,2012:140-143.
[25]何士科.神经内镜下经单鼻孔蝶窦入路切除垂体瘤的疗效观察[J].浙江医学,2017,39(12):1025-1027.doi:10.12056/j.issn.1006-2785.2017.39.12.2016-1861.
[26]俞雷,鲁晓杰,王清,等.国内显微镜和神经内镜下经鼻蝶窦垂体腺瘤切除术后临床疗效的Meta分析[J].中华神经外科杂志,2014,30(10):1023-1026.doi:10.3760/cma.j.issn.1001-2346.2014.10.014.
[27]周涛,魏少波,孟祥辉,等.单纯神经内镜下经鼻蝶入路垂体瘤切除术[J].中华外科杂志,2010,48(19):1443-1446.doi:10.3760/cma.j.issn.0529-5815.2010.19.002.
[2]Cappabianca P,Cavallo LM,Solari D,et al.Endoscopic endonasal surgery for pituitary adenomas[J].World Neurosurg,2014,82(6):S3-S11.doi:10.1016/j.wneu.2014.07.019.
[3]Dehdashti AR,Ganna A,Karabatsou K,et al.Pure endoscopic endonasal approach for pituitary adenomas:early surgical results in 200patients and comparison with previous microsurgical series[J].Neurosurgery,2008,62(5):1006-1015.doi:10.1227/01.neu.0000325862.83961.12.
[4]Aflorei ED,Korbonits M.Epidemiology and etiopathogenesis of pituitary adenomas[J].J Neurooncol,2014,117(3):379-394.doi:10.1007/s11060-013-1354-5.
[5]Scheithauer BW,Gaffey TA,Lloyd RV,et al.Pathobiology of pituitary adenomas and carcinomas[J].Neurosurgery,2006,59(2):341-353.
[6]Zaidi HA,Reyes KDL,Barkhoudarian G,et al.The utility of high-resolution intraoperative MRI in endoscopic transsphenoidal surgery for pituitary macroadenomas:early experience in the advanced multimodality image guided operating suite[J].Neurosurg Focus,2016,40(3):E18.doi:10.3171/2016.1.FOCUS15515.
[7]王勇,吴冲,张洪亮,等.神经内镜下切除功能性垂体瘤术后激素水平改善的效果分析[J].临床神经外科杂志,2015,17(4):265-268.doi:10.3969/j.issn.1672-7770.2015.04.007.
[8]Ogra S,Nichols AD,Stylli S,et al.Visual acuity and pattern of visual field loss at presentation in pituitary adenoma[J].J Clin Neurosci,2014,21(5):735-740.doi:10.1016/j.jocn.2014.01.005.
[9]郭振华,丁长青,史先基,等.首诊于眼科的鞍区病变53例临床与磁共振成像分析[J].广西医学,2015,37(9):1326-1327.doi:10.11675/j.issn.0253-4304.2015.09.35.
[10]耿亚东,魏新亭,薛亚珂,等.神经内镜下经鼻蝶入路切除垂体腺瘤99例[J].实用医学杂志,2017,33(24):4197-4198.doi:10.3969/j.issn.1006-5725.2017.24.045.
[11]Yano S,Hide T,Shinojima N.Efficacy and complications of endoscopic skull base surgery for giant pituitary adenomas[J].World Neurosurg,2017,99:533-542.doi:10.1016/j.wneu.2016.12.068.
[12]Nieman L,Biller B,Findling J,et al.Withdrawn:the diagnosis of Cushing's syndrome:an endocrine society clinical practice guideline[J].Eur J Endocrinol,2009,11(2):147-153.doi:10.1530/EJE-09-0695.
[13]Woodworth GF,Patel KS,Shin B,et al.Surgical outcomes using a medial-to-lateral endonasal endoscopic approach to pituitary adenomas invading the cavernous sinus[J].J Neurosurg,2014,120(5):1086-1094.doi:10.3171/2014.1.JNS131228.
[14]王勇,吴冲,张洪亮,等.神经内镜下切除功能性垂体瘤术后激素水平改善的效果分析[J].临床神经外科杂志,2015,12(4):265-268.doi:10.3969/j.issn.1672-7770.2015.04.007.
[15]郑文键,李维平,纪涛,等.神经内镜经鼻蝶入路垂体瘤切除术的临床疗效和并发症分析[J].中华神经医学杂志,2015,14(6):609-613.doi:10.3760/cma.j.issn.1671-8925.2015.06.014.
[16]Babey M,Sahli R,Vajtai I,et al.Pituitary surgery for small prolactinomas as an alternative to treatment with dopamine agonists[J].Pituitary,2011,14(3):222-230.doi:10.1007/s11102-010-0283-y.
[17]中国垂体腺瘤协作组.中国垂体催乳素腺瘤诊治共识(2014版)[J].中华医学杂志,2014,94(31):2406-2411.doi:10.3760/cma.j.issn.0376-2491.2014.31.004.
[18]Qu X,Xu G,Qu Y,et al.The pseudocapsule surrounding a pituitary adenoma and its clinical significance[J].J Neurooncol,2011,101(2):171-178.doi:10.1007/s11060-010-0247-0.
[19]张红赟,邢振义,孙来广.神经内镜与显微镜下经鼻蝶垂体瘤切除术的对比[J].中华实验外科杂志,2015,32(3):618-620.doi:10.3760/cma.j.issn.1001-9030.2015.03.062.
[20]马军辉.内分泌激素水平与垂体瘤手术远期疗效的相关性研究[J].临床研究,2015,23(5):218-219.doi:10.3969/j.issn.1004-8650.2015.05.216
[21]Guiot J,Rougerie J,Fourestier M,et al.Intracranial endoscopic explorations[J].Presse Med,1963,71:1225-1228.
[22]田新华,张俊卿,陈锷,等.显微镜与神经内镜下经单鼻孔蝶窦垂体腺瘤切除术的比较[J].中华神经外科杂志,2007,23(3):182-184.doi:10.3760/j.issn:1001-2346.2007.03.008.
[23]鲁晓杰,陈开来,王清,等.内镜和显微镜下经鼻入路鞍区的解剖学对比研究[J].中华显微外科杂志,2010,33(2):140-142.doi:10.3760/cma.j.issn.1001-2036.2010.02.019.
[24]张亚卓,邸虓.内镜神经外科学[M].人民卫生出版社,2012:140-143.
[25]何士科.神经内镜下经单鼻孔蝶窦入路切除垂体瘤的疗效观察[J].浙江医学,2017,39(12):1025-1027.doi:10.12056/j.issn.1006-2785.2017.39.12.2016-1861.
[26]俞雷,鲁晓杰,王清,等.国内显微镜和神经内镜下经鼻蝶窦垂体腺瘤切除术后临床疗效的Meta分析[J].中华神经外科杂志,2014,30(10):1023-1026.doi:10.3760/cma.j.issn.1001-2346.2014.10.014.
[27]周涛,魏少波,孟祥辉,等.单纯神经内镜下经鼻蝶入路垂体瘤切除术[J].中华外科杂志,2010,48(19):1443-1446.doi:10.3760/cma.j.issn.0529-5815.2010.19.002.