侵袭性垂体瘤致颈内动脉海绵窦段移位的研究

Intracavernous internal carotid artery displacement caused by invasive pituitary adenoma

目的探讨不同Knosp分级的垂体瘤对颈内动脉海绵窦段推移的影响。方法通过测量垂体瘤组和对照组的双侧颈内动脉海绵窦段间距,比较两组以及亚组之间显著性差异。结果 Knosp 0级~Ⅳ级组、对照组双侧颈内动脉海绵窦段水平段间距均值分别为15.64、18.63、24.05、29.13、30.05、13.57 mm。对照组与0级组差异无统计学意义(P=0.179),与Ⅰ级组~Ⅳ级组差异均有统计学意义(P<0.001);0级组与Ⅰ级组~Ⅳ级组差异有统计学意义(P=0.034,P<0.001);Ⅰ级组与Ⅱ级组~Ⅳ级组间差异有统计学意义(P<0.001);Ⅱ级组与Ⅲ级组、Ⅳ级组之间差异有统计学意义(P=0.000);Ⅲ级组与Ⅳ级组差异无统计学意义(P=0.680)。结论侵袭性垂体瘤对颈内动脉海绵窦段有推移作用,Knosp级别越高,对颈内动脉推移作用越大。

Objective To explore the effect of invasive pituitary adenoma at different stages on the cavernous segment displacement of internal carotid artery. Methods The distance between the bilateral intracavernous internal carotid artery segment in median were measured in MRI images; the differences among the invasive pituitary adenoma,non-saddle region lesions and subgroups of invasive pituitary adenoma were analyzed. Results The distance of bilateral internal carotid artery segment in Knosp classification grade 0,Ⅰ,Ⅱ,Ⅲ,Ⅳ invasive pituitary adenomas and non-saddle lesion（ control group）were 15. 64,18. 63,24. 05,29. 13 and 30. 05 mm,respectively. There was no significant difference between the control group and the grade 0 subgroup of pituitary adenoma（ P = 0. 179）; while there were significant differences between the control group and grade Ⅰ,Ⅱ,Ⅲ,Ⅳ of invasive pituitary adenomas（ P〈0. 001）,between grade 0 and grade Ⅰ,Ⅱ,Ⅲ,Ⅳ subgroups of pituitary adenomas（ P〈0. 001）,between grade Ⅰ and grade Ⅱ,Ⅲ,Ⅳ（ P〈0. 001）,between grade Ⅱ and grade Ⅲ,Ⅳ（ P〈0. 001）; however,there was no significant difference between grade Ⅲ and grade Ⅳsubgroups（ P = 0. 680）. Conclusion Invasive pituitary adenoma can cause displacement of the intracavernous internal carotid artery,the displacement is correlated with the Knosp grading. In transsphenoidal approach the attention should be paid to the shift of the intracavernous internal carotid artery caused by the invasive pituitary adenoma.