显微镜下经鼻蝶窦入路垂体腺瘤术后复发的危险因素分析

Analysis of risk factors of the recurrence after microscopic resection of pituitary tumors by transsphenoidal surgery

目的探讨显微镜下经鼻蝶窦入路手术治疗垂体腺瘤患者术后复发的危险因素。方法对2012年1~6月显微镜下经鼻蝶窦入路手术治疗的、术后病理证实为垂体腺瘤的100例患者进行术后随访分析,其中术后肿瘤复发8例,未复发92例,行Kaplan-Meier生存分析和多因素逐步COX回归分析,寻找术后复发相关的临床危险因素。结果单因素分析中术前视力下降（P=0.007）、术后残留（P=0.042）、鞍上侵袭（P=0.004）、手术切除程度（P=0.021）、术前视野缺损（P=0.009）及术后海绵窦残留（P=0.039）是术后复发的危险因素,多因素逐步COX回归分析中鞍上侵袭是导致术后复发的主要危险因素（P=0.029）。结论显微镜下经鼻蝶窦入路垂体腺瘤术后复发受多种因素影响,其中鞍上侵袭是主要危险因素,针对相关危险因素在手术中采取有效的措施,可以大大降低术后复发的几率。

Objective To analyze the clinical factors causing the recurrence after microscopic resection of pituitary tu-mors by transsphenoidal surgery. Methods Selected 100 cases of microscopic transsphenoidal approach for resection of pitu-itary tumour from Jan 2012 to Jun 2012, included 8 cases with recurrence and 92 cases without recurrence. Kaplan-Meier and multiple COX regression analysis were conduced for the relevant factors. Results Single factor analysis showed that preopera-tive visual decline（P=0.007）, postoperative residual （P=0.042）, defection of visual field（P=0.009）, degree of surgical resection （P=0.021）, invasive suprasellar （P=0.004） and postoperative residual of sinus cavernous （P=0.039） were the related risk fac-tors for the recurrence after microscopic resection of pituitary adenoma after transsphenoidal approach. Invasive suprasellar was the main infection-related factor of postoperative recurrence of pituitary adenoma in the multivariable COX method analysis （P=0.029）. Conclusion The recurrence after microscopic resection of pituitary adenoma by transsphenoidal approach seems to be affected by many factors. It is invasive suprasellar that mostly affect the recurrence of pituitary adenoma by transsphenoidal approach. It can decrease the rate of postoperative recurrence of pituitary adenoma through taking effective measures for those relative risk factors.