经鼻蝶入路鞍区占位切除术治疗伴高泌乳素血症无功能垂体腺瘤的疗效

Endonasal transsphenoidal sellar tumor resection in treating non-functioning pituitary adenomas with hyperprolactinemia:an analysis of efficacy

目的探讨经鼻蝶入路鞍区占位切除术治疗伴高泌乳素血症无功能垂体腺瘤的效果。方法回顾性纳入2015年1月1日至2019年12月31日于我院神经外科接受经鼻蝶入路鞍区占位切除术治疗、泌乳素水平>25 ng/mL但<200 ng/mL的无功能垂体腺瘤患者80例。分析患者的临床特征、手术方式、术后并发症、术后高泌乳素血症及临床症状的缓解情况,并采用logistic回归模型分析术后高泌乳素血症缓解的预测因素。结果80例患者中男21例,女59例,术前泌乳素水平为51.11(25.20~136.52)ng/mL,肿瘤体积为3.99(0.23~37.11)cm3,头痛为最常见的首发症状(37.5%,30/80)。男女患者首发症状差异有统计学意义(P=0.031),女性患者中以性腺功能障碍起病者占比高于男性[28.8%(17/59)vs 9.5%(2/21)];男性患者在就诊时更容易出现2条及以上垂体激素功能轴功能减退(47.6%,10/21),与女性患者(15.3%,9/59)相比差异有统计学意义(P=0.025)。80例患者均接受经鼻蝶入路鞍区占位切除术治疗,完全及近完全切除占88.8%(71/80)。65例(81.2%)患者在术后3个月内高泌乳素血症缓解,术后3个月泌乳素水平为13.44(1.74~24.19)ng/mL;未缓解患者15例,术后3个月泌乳素水平为32.69(25.20~115.23)ng/mL。高泌乳素血症缓解组患者的术前及术后第1天泌乳素水平与未缓解组相比均较低[术前:45.47(25.20~136.52)ng/mL vs 64.82(33.17~130.88)ng/mL,P=0.003;术后第1天:13.12(0.60~36.35)ng/mL vs 40.06(26.25~118.01)ng/mL,P<0.01],但两组患者的性别、年龄、肿瘤体积、手术方式、肿瘤切除程度差异均无统计学意义(P均>0.05)。多因素logistic回归多因素分析显示,术后第1天泌乳素水平≤25 ng/mL是无功能垂体腺瘤患者术后3个月高泌乳素血症缓解的独立预测因素(OR=13.500,95%CI 3.623~50.298,P<0.01)。术后患者视力视野改善率为87.9%(29/33),头痛症状改善率为93.9%(31/33),17例术前存在月经紊乱的女性患者中14例(82.4%)术后恢复正常月经周期。结论经鼻蝶入路鞍区占位切除术是伴高泌乳素血症的无功能垂体腺瘤患者的可靠治疗选择。

Objective To explore the therapeutic effect of endonasal transsphenoidal sellar tumor resection surgery for the treatment of non-functioning pituitary adenoma patients with hyperprolactinemia.Methods A total of 80 non-functioning pituitary adenoma patients with serum prolactin level>25 ng/mL and<200 ng/mL,who underwent endonasal transsphenoidal sellar tumor resection surgery in the Department of Neurosurgery of our hospital from Jan.1,2015 to Dec.31,2019,were retrospectively included.The clinical characteristics,surgical methods,postoperative complications,and the relief of postoperative hyperprolactinemia and clinical symptoms were analyzed.The predictive factors of postoperative hyperprolactinemia remission were analyzed using logistic regression.Results Out of the 80 patients,21 were males and 59 were females.The preoperative prolactin level was 51.11(25.20-136.52)ng/mL,and the tumor volume was 3.99(0.23-37.11)cm3.Headache was the most common initial symptom(37.5%,30/80).There was significant difference in the initial symptoms between the male and female patients(P=0.031),and the female patients were more likely to present with hypogonadotropic hypogonadism compared with the male patients(28.8%[17/59]vs 9.5%[2/21]).The male patients were significantly more likely to have two or more hormonal axis dysfunctions(47.6%[10/21]vs 15.3%[9/59],P=0.025).All the 80 patients received the resection surgery and 88.8%(71/80)of them achieved gross or near total resection.Sixty-five(81.2%)patients had remission of hyperprolactinemia within 3 months after surgery,and the prolactin level was 13.44(1.74-24.19)ng/mL 3 months after surgery;15 patients had no remission,and the corresponding prolactin level was 32.69(25.20-115.23)ng/mL.The prolactin levels before and 1 d after surgery were significantly lower in the remission group than those in the non-remission group(preoperative:45.47[25.20-136.52]ng/mL vs 64.82[33.17-130.88]ng/mL,P=0.003;postoperative day 1:13.12[0.60-36.35]ng/mL vs 40.06[26.25-118.01]ng/mL,P<0.01).There were no significant differences in gender,age,tumor volume,surgical methods or extent of tumor resection between the two groups(all P>0.05).Multivariate logistic regression analysis showed that prolactin level≤25 ng/mL on postoperative day 1 was an independent predictor of remission of hyperprolactinemia(odds ratio 13.500,95%confidence interval 3.623-50.298,P<0.01).The visual defect and headache improvement rates were 87.9%(29/33)and 93.9%(31/33),respectively.Among the 17 female patients with menstrual disorders before surgery,14(82.4%)returned to normal menstrual cycles.Conclusion Endonasal transsphenoidal sellar tumor resection surgery is a reliable treatment option for non-functioning pituitary adenoma patients with hyperprolactinemia.