【作者】 杨斌；

【导师】 秦治刚；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2024， 硕士

【摘要】 目的:本研究通过对比分析238例不同Knosp分级垂体腺瘤(Pituitary adenoma,PA)患者在神经内镜单鼻道经鼻蝶手术情况,探讨其达全切程度的影响因素,并评估其术后效果及并发症情况,旨在为临床更加有效及全面评估提供参考依据,从而更好地进行手术全程管理。方法:本研究选取2017年1月到2022年12月间就诊于我中心的406例经过神经内镜单鼻道经鼻蝶PA切除术的患者。经过纳入及排除标准,最终筛选238例患者为研究对象,对其临床表现,影像资料,生化检查,病理结果及术后并发症等信息进行详细收集。根据Knosp分级,将其分为0、1、2、3、4共5组患者。分析238例患者总体术前、术中及术后情况,并进一步对比分析5组患者术前(年龄、性别、术前症状、肿瘤类型、肿瘤来源、肿瘤直径)、术中(平均手术时间、平均出血量、切除程度、术中情况)资料,然后进行多因素Logistic回归分析,筛选PA完全切除的的独立影响因素,最后对比分析5组术后疗效及复发情况。以P<0.05表示差异具有统计学意义。结果:1.238例总体平均年龄54.00(44.00,62.00)岁。切除程度达全切175例(73.5%),近全切50例(21.0%),部分切13例(5.5%),海绵窦肿瘤切除程度(Knosp 3、4级)达全切58例(51.3%),近全切42例(37.2%),部分切13例(11.5%)。术中脑脊液漏67例(28.2%),肿瘤质地韧57例(23.9%),颈动脉损伤3例(1.2%),术后并发症中持续性尿崩占比最高为5.8%。2.不同Knosp分级术前及术中情况对比结果表明,Knosp 0-4级五组间在年龄、性别、肿瘤类型方面差异无统计学意义(P均>0.05);在术前症状、肿瘤来源、肿瘤直径、平均手术时间、平均出血量、切除程度及术中情况方面差异存在统计学意义(P均<0.05)。3.二元Logistic回归分析结果表明Knosp分级(OR=1.738,P=0.027)、术中情况(OR=6.212,P=0.000)是影响PA完全切除的独立影响因素。4.不同Knosp分级术后疗效对比结果表明,五组间在术后情况、激素缓解方面差异无统计学意义(P均>0.05);在复发情况方面差异存在统计学意义,其中Knosp 3级、4级复发率高于Knosp 0-2级(P均<0.05)。结论:1、神经内镜下单鼻道经鼻蝶入路切除不同Knosp分级PA可行且安全有效。2、Knosp分级及术中情况是影响神经内镜下单鼻道经鼻蝶入路完全切除PA的独立影响因素,术前进行Knosp分级结合术中情况,可在一定程度上评估预测病变切除程度。3、PA复发可能是多因素作用结果,本研究结果发现Knosp分级越高,其复发率可能越高。更多还原

【Abstract】 Objective:In this study,we investigated and comparatively analyzed the degree of resection of pituitary adenomas in 238 patients with different Knosp graded in neuroendoscopic mononasal transsphenoidal pituitary adenomas and the factors affecting them,and assessed their postoperative outcomes and complications,to provide reference basis for a more effective and comprehensive clinical preoperative assessment,and thus a better intra-operative and postoperative management.Methods:In this study,406 patients who underwent neuroendoscopic single nasal passage transnasal pterygoid pituitary adenoma resection who visited our center between January 2017 and December 2022 were selected.After the inclusion and exclusion criteria,238 patients were finally screened for the study and detailed information on their clinical presentation,imaging data,biochemical examination,pathological findings,and postoperative complications were collected.According to the Knosp classification,they were divided into 5 groups of 0,1,2,3,and 4 patients.The overall preoperative,intraoperative,and postoperative conditions of 238 patients were analyzed and further compared and analyzed with the preoperative(age,gender,preoperative symptoms,tumor type,tumor source,tumor diameter,previous),intraoperative(average operation time,average bleeding,degree of resection,intraoperative conditions)information of the 5 groups of patients,then multifactorial logistic regression analysis was performed to screen the independent influencing factors for complete resection of PA.Finally,the postoperative efficacy and recurrence of the five groups were compared and analyzed.Differences were expressed as statistically significant at P < 0.05.Results:1.The overall mean age of the 238 cases was 54.00(44.00,62.00)years.The extent of resection reached total resection in 175 cases(73.5%),near-total resection in50 cases(21.0%),and partial resection in 13 cases(5.5%),and the extent of cavernous sinus tumor resection(Knosp 3,4)reached total resection in 58 cases(51.3%),near-total resection in 42 cases(37.2%),and partial resection in 13 cases(11.5%).Intraoperative cerebrospinal fluid leakage was found in 67 cases(28.2%),tumor texture was tough in57 cases(23.9%),and carotid artery injury was found in 3 cases(1.2%).2.Comparison of preoperative and intraoperative conditions of different Knosp grades showed that there were no statistically significant differences in age,gender,and type of tumor among the five Knosp grade 0-4 groups(P > 0.05);and there were statistically significant differences in preoperative symptoms,tumor source,tumor diameter,average operation time,average bleeding,degree of resection and intraoperative conditions(P < 0.05).3.Binary logistic regression analysis showed that Knosp grade(OR=1.738,P=0.027)and intraoperative situation(OR=6.212,P=0.000)were independent influences on the complete resection of PA.4.The results of the comparison of postoperative efficacy of different Knosp grades showed that there was no statistically significant difference between the five groups in terms of postoperative situation and hormonal remission(P > 0.05);there was a statistically significant difference in terms of recurrence,in which the recurrence rate of Knosp grades 3 and 4 was higher than that of Knosp grades 0-2(P < 0.05).Conclusion:1,Neuroendoscopic single-nasal transnasal butterfly approach for resection of PA with different Knosp grades is feasible,safe,and effective.2,Knosp grade and intraoperative situation are independent factors influencing the degree of complete resection of PA by neuroendoscopic single nasal channel transnasal butterfly approach,and the preoperative Knosp grade combined with the intraoperative situation can be assessed to predict the degree of resection of lesions to a certain extent.3,PA recurrence may be the result of multifactorial effects,and the results of this study found that the higher the Knosp grading,the higher the degree of recurrence may be.更多还原