经鼻蝶入路垂体腺瘤切除术对视力的影响及相关因素分析

Analysis on vision changes and related factors of transnasal transsphenoidal pituitary adenoma resection

目的探讨经鼻蝶入路垂体腺瘤切除术对视力改善的作用及影响术后视力改善的相关因素，建立回归方程。方法左眼视力与右眼视力分别进行比较，术后视力与术前视力比较采用配对t检验，对相关因素应用多分类有序反应变量的logistic回归模型进行分析。结果配对t检验表明，经鼻蝶入路垂体腺瘤切除术后双眼视力较术前均有明显改善[左眼：术前视力（0．8±0．6），术后视力（0．9±0．6），t=-4．716，P=0．005；右眼：术前视力（0．9±0．5）、术后视力（1．0±0．5），t=-4．976，P=0．004]；应用累积logistic回归模型筛选出两个对术后视力有影响的变量为肿瘤长径和术前视力。肿瘤长径越大，术后视力改善越明显（Wald χ^2=0．047，OR=2．240，P=0．047）；术前视力下降程度越重，术后视力改善越明显（Wald）（χ^2=9．684，OR=0．010，P=0．001）。而患者年龄、性别、病理类型、切除程度、视力下降出现时间对术后视力改善均无影响。结论t经鼻蝶入路垂体腺瘤切除术能明显改善患者视力，改善程度与肿瘤直径和术前视力下降的程度有关。

Objective To investigate the factors affecting the vision recovery after transnasal transsphenoidal pituitary adenoma resection. Methods The vision of the left eyes and the right eyes were compared respectively. The vision after and before the operation was also compared by using paired t-test, related factors were analyzed by multiple variable logistic regression model. Results The paired t-test indicated that both eyes＇ visions were improved after transnasal transsphenoidal pituitary adenoma resection（P 〈 0. 01 ）. The tumor diameter and the vision before operation were two factors affecting the post-operative visions by cumulative logistic regression model. The larger the diameters of the tumors were, the better the vision recoveries after operation（ Wald χ^2=0. 047, OR =2. 240,P =0. 047）. Worse vision lose before operation came up with a better recovery after operation（ Wald χ^2 = 9. 684, OR = 0. 010, P = 0. 001 ） ; however, age, gender, pathological category, the extent of tumor removal and the time of the vision loss have no significant affects on the vision recovery after operation. Conclusion The transnasal transsphenoidal pituitary adenoma resection can improve the vision of the patients, and the degree which would to be improved is correlated with the tumor diameter and the vision lose before operation.