垂体瘤术后视野改善的时程特征及改善程度的影响因素

Time-Dependent Characteristics and Prognostic Factors of Visual FieldImprovement in Patients after Endonasal Transsphenoidal Pituitary TumorResection

目的通过对垂体瘤患者进行术前及术后不同时间点中心静态视野的定量分析,来探讨经鼻蝶垂体瘤切除术后患者视野改善时程的特征,以及术后视野改善程度的影响因素.方法：回顾性系列病例研究.收集2013 年1 月至2016 年2 月在复旦大学附属上海市第五人民医院行经鼻蝶垂体瘤切除术且术前有视野缺损的垂体瘤患者110 例（212 眼）,对其中在术后1 周复查视野有改善且术后3、6、12 个月时随访资料完整的30 例患者（45 眼）视野改善的时程特征进行分析.采用平均缺损（MD）定量分析视野.对各影响因素先进行单因素分析,再进行多因素Logistic回归分析.结果：随访资料完整的30例患者视野在术后1周时改善最为明显,而后随时间推移视野改善程度逐渐趋于平缓,其中有1例患者在术后12个月时出现垂体瘤复发.110例患者手术后1周视野正常、改善、无改善者最佳矫正视力（BCVA）、视野MD绝对值、全颞上象限视野缺损、视交叉压迫以及肿瘤最大径的差异有统计学意义（F=17.025,P 〈0.001;F=37.580,P 〈 0.001;χ2=17.459,P 〈 0.001;χ2=11.296,P=0.004;F=13.197,P 〈 0.001）;多因素Logistic回归分析显示术前BCVA（β=2.241,P=0.011,OR=9.406）、术前视野MD绝对值（β=0.195,P 〈 0.001,OR=1.215）、术前全颞上象限视野缺损（β=1.614,P=0.002,OR=5.024）、肿瘤最大径（β=0.512,P=0.023,OR=1.668）为影响术后视野改善程度的相对独立的影响因素.结论：经鼻蝶垂体瘤切除术后患者视野在术后1 周时改善最为迅速.术前BCVA、术前视野MD绝对值、术前全颞上象限视野缺损和肿瘤最大径为影响垂体瘤患者术后视野改善程度的相对独立影响因素.

Objective： To analyze the time-dependent characteristics and possible prognostic factors for postoperativevisual field improvement in patients after undergoing endonasal transsphenoidal pituitary tumor resectionsurgery. Methods： This retrospective case series study included 110 patients （212 eyes） who with visualfield defect underwent endonasal transsphenoidal pituitary tumor resection at the Fifth People＇s Hospital ofShanghai Fudan University between January 2013 and February 2016. Preoperative scans of the pituitary were made by computed tomography or magnetic imaging resonsance. Preoperative eye examinationsincluded visual acuity, refraction, slit-lamp examination, fundus examination, intraocular pressuremeasurement, and central static visual field perimetry with a Humphrey-750i perimeter. Visual fields weremeasured again 1 week after surgery. Thirty patients （45 eyes） with visual field improvement and complete 3,6, and 12 months follow-up data were analyzed for visual field improvement tendency. The mean deviation（MD） was used to quantify the visual field defect. Univariate analysis and multivariate logistic regressionanalysis for the prognostic factors of postoperative visual field improvement were carried out with SPSS24.0 statistical software. Results： In the 30 patients with complete follow-up data, there was significantimprovement in the postoperative visual field at 1 week after surgery, but the rate of improvementgradually declined over time. One patient experienced a pituitary tumor recurrence 12 months after surgery.There were significant differences in preoperative best corrected visual acuities （F=17.025, P 〈 0.001）,preoperative MD absolute values （F=37.580, P 〈 0.001）, preoperative full superotemporal quadrant visualfield defects （χ2=17.459, P 〈 0.001）, optic chiasm compressions （χ2=11.296, P=0.004）, and maximum tumordiameters （F=13.197, P 〈 0.001） among the normal, improved, and unimproved postoperative visual fieldgroups. Multivariate logistic regression analysis indicated that preoperative best corrected visual acuity（BCVA） （β=2.241, P=0.011, OR=9.406）, preoperative MD absolute value （β=0.195, P 〈 0.001, OR=1.215）,preoperative full superotemporal quadrant visual field defect （β=1.614, P=0.002, OR=5.024）, and themaximum tumor diameter （β=0.512, P=0.023, OR=1.668） were the relatively independent prognosticfactors for postoperative visual field improvement. Conclusions： After endonasal transsphenoidal pituitarytumor resection surgery, the visual field improvement was greatest at 1 week. Preoperative BCVA, preoperativeMD absolute value, preoperative full superotemporal quadrant visual field defect, and the maximum tumordiameter were the relatively independent prognostic factors for postoperative visual field improvement.Key words： visual field defect; pituitary tumor; endonasal transsphenoidal pituitary tumor resection;time-dependent characteristics