手术治疗侵袭性垂体腺瘤患者的预后研究

Prognosis of Surgical Treatment for Patients with Invasive Pituitary Adenomas

目的探讨手术治疗侵袭性垂体腺瘤患者的预后。方法回顾性分析我院神经外科侵袭性垂体腺瘤的术后临床疗效,共50例,均行手术治疗,其中经鼻蝶37例,分期经鼻蝶3例,经颅5例,联合入路5例。全切除17例,次全切除18例,部分切除15例。结果术后症状改善12例,缓解8例,未愈6例。术后辅助治疗15例。复发17例,复发率34%,复发患者平均无复发生存时间36.1个月。肿瘤切除程度,术后是否予以辅助治疗以及是否有肿瘤包绕颈内动脉与预后明显相关。结论侵袭性垂体腺瘤采取以手术为主的综合治疗策略,经鼻蝶入路可以成为侵袭性垂体腺瘤手术治疗的首选方式,术后辅助治疗能够延长无复发生存时间。

Objective To analyze the clinical outcome of invasive pituitary adenomas by surgery .Methods Clinical effect of surgery for 50 cases of invasive pituitary tumor were retrospectively analyzed .37 cases received trans-sphenoid surgery ,3 staged trans-sphenoid surgery ,5 transcranial surgery and 5 trans-sphenoid combined with transcranial operation .17 patients re-ceived gross total resection ,18 subtotal resection,and 15 partial resection.Results 15 cases received postoperative adjunctive therapy;12 patients improved ,8 alleviated and 6 unrecovered .Recurrence during the follow-up occurred in 17 patients （ 34%） . The average recurrence-free survival was 36.1 months.The degree of tumor resection ,postoperative adjunctive therapy and enca-sing the internal carotid arteries were associated with the prognosis .Conclusion Invasive pituitary adenomas should be treated with multimodality therapy ,trans-sphenoidal surgery should be the first choice ,and postoperative adjunctive therapy can prolong recurrence-free survival .