影响垂体大腺瘤主要扩展方向的相关因素

Analysis of related factors influencing the main extended direction of pituitary macroadenoma

目的探讨影响垂体大腺瘤沿垂直方向上扩展的相关因素。方法回顾性分析184例垂体大腺瘤患者，根据肿瘤的鞍上扩展值（suprasellar extension value，SEV），将其分为主要向鞍上扩展（SEV〉0）和主要向鞍下扩展（SEV≤0）2组。以肿瘤垂直方向上的主要扩展方向为因变量，选取可能对其产生影响的10个指标（患者年龄、性别、肿瘤类型、鞍隔孔直径、蝶窦类型、蝶鞍上口形态、蝶窦主隔的偏向、蝶窦主隔的最大宽度、肿瘤囊变、蝶窦纵隔的数目）作为自变量，进行多因素Logstic回归分析，筛选出对肿瘤沿垂直方向扩展有价值的影响因素。结果主要向鞍上扩展121例，主要向鞍下扩展63例。统计分析显示，肿瘤类型（P=0．026）、蝶窦类型（P=0．003）、蝶鞍上口的形态（P=0．046）、鞍隔孔直径（P=0．003）、蝶窦主隔的最大宽度（聘0．009），是影响垂体腺瘤沿垂直方向上扩展的独立预测因素。结论蝶鞍型或鞍枕型蝶窦、囊袋型蝶鞍的上口、生长激素型腺瘤、鞍隔孔直径小和蝶窦主隔宽度较小的患者，垂体大腺瘤更趋于向鞍下扩展；鞍前型蝶窦、炒锅型或直桶型蝶鞍的上口、非生长激素型腺瘤、鞍隔孔直径大和蝶窦主隔宽度较大的患者，垂体大腺瘤更趋于向鞍上扩展。

Objective To investigate the related influence factors of the main extended direction of the pituitary macroadenoma in the vertical direction. Methods Clinical data of 184 pituitary macroadenoma patients were collected and analyzed retrospectively. The main extended direction in the vertical direction of the tumor was taken as the dependent variables. Patients were divided into two groups according to the suprasellar extension value of each tumor, （ie： suprasellar extension value〉0 and suprasellar extension value ≤ 0）. 10 selected indicators （age, sex, tumor type, diameter of diaphragmatic opening, sphenoid sinus type, sella type morphology, main sphenoid sinus septum bias, maximum width of sphenoid sinus septum, tumor cyst, number of longitudinal sphenoid sinus septum） were taken as independent variables and the factors which may influence the main extended direction were analyzed and selected by logistic regression method. Results Among the 184 patients, there were 121 cases extending mainly to the suprasellar direction, while the left cases extending mainly to the opposite direction. Statistical analysis showed the tumor type （P=0.026）, sphenoid sinus type （P=0.003）, sella type morphology（P=0.046）, diameter of diaphragmatic opening （P=0.003） and maximum width of the sphenoid sinus septum （P=0.009） were the independent predictors influencing the main expansion direction of pituitary macroadenomas in the vertical direction. Conclusions The pituitary macroadenoma is more likely to expand infrasellar in patients with sellar or sellaoccipital sphenoid sinus, sac sella turcica morphology, GH adenoma, smaller diaphragmatic opening diameter and narrower width of sphenoid sinus septum. The pituitary macroadenoma is more likely to expand suprasellar in patients with presellar sphenoid sinus, wok and cylinder sella turcica morphology, non- GH adenoma, larger diaphragmatic opening diameter and wider width of sphenoid sinus septum.