内镜手术治疗性腺功能低下垂体瘤患者的疗效分析

Efficacy of endoscopic surgery hypogonadism pituitary tumor patients

目的探讨内镜手术治疗性腺功能低下的垂体瘤患者的临床疗效。方法回顾性的分析2013年10月-2015年2月新疆医科大学第一附属医院神经外科收治的经神经内镜手术治疗的伴有性腺功能低下的125例垂体瘤患者的临床资料(男性患者无前列腺炎,女性患者无宫颈炎、多囊卵巢综合征等),通过术前、术后抽血检测患者的内分泌指标及问卷调查评估患者的性功能,并根据术后患者问卷调查分数将患者分为恢复正常组、部分恢复组、无变化组、恶化组,分析影响患者手术疗效的因素。结果 125例性腺功能低下的垂体瘤患者手术切除情况:全切94例,大部切除22例,部分切除9例。术后病理结果:无功能腺瘤48例,泌乳素垂体腺瘤55例,生长激素垂体腺瘤18例,促肾上腺皮质激素垂体腺瘤3例,多激素型垂体腺瘤1例。术后并发症:暂时性尿崩症55例,脑脊液鼻漏15例,水与电解质紊乱25例,颅内感染2例。性腺功能改善情况:性腺功能恢复正常55例,明显提高39例,无变化24例,比术前下降7例。125例性腺功能低下的垂体瘤患者术后性腺功能改善情况与患者的年龄(P<0.01)、术前睾酮水平(P<0.05)、伴有基础疾病或不良嗜好(P<0.05)、术前性功能水平(P<0.05)、肿瘤切除情况(P<0.05)、肿瘤病理分型(P<0.05)、肿瘤最大直径(P<0.05)、病程(P<0.01)有关。125例性腺功能低下的垂体瘤患者术后性腺功能改善的积极因素包括:术前较高的睾酮水平(P=0.041)、较小的肿瘤最大直径(P=0.021)、年轻的年龄(P=0.006)、最大程度的切除肿瘤(P=0.02)、较好的身体情况和生活习惯(P=0.04)、功能性肿瘤分型(P=0.009)。症状持续时间与术前性功能不是独立的影响因素(P>0.05)。结论肿瘤全切率对于性腺功能低下的垂体瘤患者的疗效至关重要。

Objective To evaluate the clinical efficacy in pituitary tumors patients with endoscopic surgical treatment of hypogonadism.Methods A for the clinical data of 125 cases pituitary tumor patients from October 2013 to February 2015 in Xinjiang Medical University First Affiliated Hospital of Neurosurgery,who were treated by endoscopic surgery with nerve hypogonadism（male patients without prostatitis;female patients without cervicitis,polycystic ovary syndrome,etc.） were retrospectively analysed.According to the the preoperative and postoperative result of endocrine blood tests and questionnaire scores of sexual function,postoperative patients were divided into normal group,part of the recovery group,the group not changed,the deterioration group.The influencing factors of the curative effect were analyzed.Results The situation of 125 cases of hypogonadism patients with pituitary tumors surgical：full-cut 94 cases,subtotal resection in 22 cases,partial resection in 9cases.Pathological results：48cases of nonfunctioning adenomas,55 cases prolactin pituitary adenoma,18 cases of pituitary adenoma growth hormone,3cases adrenocorticotropic hormone pituitary adenoma in,1case Plurihormonal pituitary adenoma in.Postoperative complications：transient diabetes insipidus in 55cases;15cases of cerebrospinal fluid rhinorrhea;water,electrolyte disturbance in 25cases;two cases of intracranial infection.125 cases of hypogonadism in patients with pituitary tumors gonadal function were improved：55cases gonadal function returned to normal,,39 cases markedly improved,no change in 24 cases,while the gonadal function in 7cases were lower than that in preoperation The situation of gonadal function improvement in 125 cases were related to age（P〈0.01）,preoperative testosterone levels（P〈0.05）,underlying diseases or bad habits（P〈0.05）,preoperative sexual function level（P〈0.05）,tumor resection cases（P〈0.05）,tumor pathological type（P〈0.05）,tumor size（P〈0.05）,duration（P〈0.01）.The multivariate analysis showed the risk factors：the higher preoperative testosterone levels（P =0.041）,the smaller tumor size（P =0.021）.The younger age（P =0.006）,the maximum tumor resection（P =0.02）,agood physical condition and lifestyle（P =0.04）,the function of tumor type（P =0.009）.Duration of symptoms and preoperative sexual functionwere not the independent factors（P〈0.05）,are not independent factors（P〈0.05）.Conclusion The rate of total resection is very important to the treatment of hypogonadism patients with pituitary tumors.