垂体腺瘤患者视力视野受损的危险因素分析

Analysis of risk factors for visual acuity and visual field impairments in patients with pituitary adenoma

目的探讨垂体腺瘤患者视力、视野损害的危险因素及其对预后的影响。方法回顾性分析首都医科大学附属北京天坛医院神经外科2008年1月至2013年12月经手术治疗的垂体腺瘤患者的临床资料，共637例。术后3年进行随访，采用受试者工作曲线（ROC）获得影响视力、视野损害及术后恢复的危险因素的最佳临界值，取整数进行分组。结果637例患者中，436例（68．4％）术前存在视力、视野损害，其中视力下降414例，视野缺损292例。ROC曲线显示，（1）肿瘤鞍上扩展高度〈12．5mm较少对患者造成视力视野的损害，其中≤10mm组与〉10mm组比较，术前视力、视野是否受损及受损的程度差异均有统计学意义（均P〈0．叭）；（2）肿瘤鞍上扩展高度〉18．5mm对患者造成永久性视力、视野损害的风险增加，其中肿瘤鞍上扩展高度≤20mm组与〉20mm组比较，术后的视力改善及视力、视野损害（vis）评分差异有统计学意义（P〈0．01），视野的改善差异无统计学意义（P〉0．05）；（3）术前视力、视野损害的病程〉13．5个月的患者，术后视力、视野损害均较难改善，其中病程〉12个月的患者术后视力恢复及VIS评分差于≤12个月者，差异有统计学意义（P〈0．01）。结论垂体腺瘤向鞍上扩展高度越大，视力、视野损害的概率越高；术后视力、视野的改善与肿瘤向鞍上扩展的高度及视力、视野损害的病程有关。

Objective To investigate the risk factors for visual acuity and visual field impairments, and the effect on their prognoses. Methods The clinical data of 637 patients with pituitary adenoma operated at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2008 to December 2013 were analyzed retrospectively. The patients were followed up at 3 years after procedure. Receiver operating characteristic （ ROC ） curve was used to obtain the optimal critical value of the risk factors for affecting visual acuity and visual field impairments and postoperative recovery. The round numbers were taken to group. Results In 637 patients, 436 （68.4%） experienced visual acuity and visual field impairments, 414 of them had decreased vision, and 292 had visual field defect. Receiver operating characteristic （ROC） curve showed that （ 1 ） the suprasellar extension height of tumors 〈 12.5 mm tended to cause less visual acuity and visual field impairments in patients. There was significant difference in whether the preoperative visual acuity and visual field were impaired and the degree of visual impairment between the ≤ 10 mm group and the 〉 10 mm group （ all P 〈 0.01 ） ; （2） the suprasellar extension height of the tumors 〉 18.5 ram, the risk of causing permanent visual acuity and visual field impairments increased. There were significant differences in postoperative visual acuity improvement, visual acuity and visual field impairment score （VIS） grades between the suprasellar extension height of tumors ≤20 mm group and the and 〉 20 mm group （ P 〈 0.01 ）. There was no significant difference in the improvement of visual field （ P 〉 0.05 ） ; （ 3 ） the patients with the duration of preoperative visual acuity and visual field impairments 〉 13.5 months, the postoperative visual acuity and visual field impairments were more difficult to improve. There was significant difference between the recovery of visual acuity in patients with the duration of the disease 〉 12 months after operation and the VIS grade pour than ≤ 12 months. Conclusions The greater the height of pituitary adenoma extendiug to the suprasaddle, the higher the probability of vist, al acuity and visual fieht impairments. The improvement of visual acuity and visual field after procedure is associated with the height of tumors extending to the st, prasaddle and the course of visual acuity and visual fiehl impairments.