侵袭性催乳素垂体瘤经内镜切除术后早期催乳素缓解因素分析

Analysis of the factors influencing early prolactin remission after endoscopic resection of aggressive prolactinomas

目的 探讨侵袭性催乳素垂体瘤经内镜切除术后早期催乳素缓解的影响因素。方法 回顾性收集2017年1月至2022年12月徐州医科大学附属医院经内镜下行垂体病损切除手术的141例侵袭性催乳素垂体瘤患者的临床资料,根据术后2周催乳素水平,分为术后早期缓解组与未缓解组。采用单因素分析2组患者的临床资料,并采用多因素logistic回归对术后早期催乳素缓解的独立预测因素进行分析。结果 在141例手术治疗的侵袭性催乳素垂体瘤患者中,有121例(85.82%)患者获得早期缓解,20例(14.18%)未缓解。早期缓解组与未缓解组在性别、肿瘤大小、肿瘤切除程度、术前催乳素水平、术后首日催乳素水平方面比较,差异具有统计学意义(P<0.05)。多因素logistic回归分析显示侵袭性催乳素垂体瘤术后首日催乳素水平是影响术后早期催乳素缓解的独立预测因素。结论 侵袭性催乳素垂体瘤的患者中,满足术后首日催乳素水平达到正常值的因素,且肿瘤侵袭性越低,肿瘤直径越小,术前测定催乳素<200μg/L,通过经神经内镜下手术治疗,做到肿瘤完全切除,患者术后2周催乳素水平更易达到早期缓解。

Objective To explore the influencing factors of early prolactin remission after endoscopic resection of aggressive prolactinomas.Methods A total of 141 patients with aggressive prolactinomas who underwent endoscopic pituitary lesion resection in the Affiliated Hospital of Xuzhou Medical University from January 2017 to December 2022 were selected and their clinical data were retrospectively analyzed.According to their prolactin levels two weeks after surgery,the patients were divided into two groups:an early remission group and a non-remission group.Their clinical data were compared through univariate analysis,while multivariate logistic regression analysis was performed to determine the independent factors predicting early postoperative prolactin remission.Results Among the 141 patients undergoing surgery for aggressive prolactinomas,121 patients(85.82%)achieved early remission,but 20 patients(14.18%)failed.Statistical differences were found between the early remission and non-remission groups in gender,tumor size,the extent of tumor resection,preoperative prolactin levels,and the prolactin levels on postoperative day one.According to multivariate logistic regression analysis,the prolactin levels on postoperative day one are an independent factor predicting early postoperative prolactin remission in patients with aggressive prolactinomas.Conclusions Patients with aggressive prolactinomas are easier to achieve early remission if their prolactin levels on postoperative day one are normal,with lower tumor metastasis,smaller tumor diameters,preoperative PRL levels<200μg/L,and complete endoscopic tumor resection.