神经内镜单侧鼻蝶入路垂体瘤切除术后复发的危险因素分析

Risk factors of recurrence after neuroendoscopic unilateral naso sphenoid approach for pituitary adenoma resection

目的探讨神经内镜单侧鼻蝶入路垂体瘤切除术后复发的危险因素。方法抽取2010年5月至2020年5月濮阳市人民医院收治的垂体瘤患者250例,均行神经内镜单侧鼻蝶入路垂体瘤切除术,术后随访1年,记录垂体瘤复发情况,分析患者基线资料,采用Logistic回归分析术后垂体瘤复发的影响因素。结果250例垂体瘤患者术后复发43例(17.20%),未复发207例(82.80%)。垂体瘤复发者肿瘤长径≥10 mm、肿瘤切除为次全切/部分切除、组织内皮细胞特异性分子1(ESM-1)阳性、组织增殖细胞核抗原标记物(Ki-67)指数≥3%比例大于未复发者(χ^(2)=33.221、31.436、10.973、15.644,P<0.05)。Logistic回归分析结果显示,肿瘤长径≥10 mmOR=5.675、P<0.05,肿瘤次全切/部分切除OR=4.743、P<0.05,组织ESM-1阳性OR=2.649、P<0.05,组织Ki-67指数≥3%OR=3.398、P<0.05。结论肿瘤长径≥10 mm,肿瘤切除程度为次全切/部分切除、组织中ESM-1阳性表达、组织Ki-67指数≥3%是脑垂体瘤患者术后复发的影响因素。

Objective To investigate the risk factors of recurrence after neuroendoscopic unilateral naso sphenoid approach for pituitary adenoma resection.Methods A total of 250 patients with pituitary adenoma treated in Puyang People’s Hospital from May 2010 to May 2020 were selected,and all patients underwent neuroendoscopic unilateral naso sphenoid approach for pituitary adenoma resection.The postoperative follow-up was 1 year and the recurrence of pituitary tumor was recorded,and the baseline data of patients were analyzed,and Logistic regression was used to analyze the influencing factors of postoperative pituitary tumor recurrence.Results Among the 250 patients with pituitary tumors,43 cases(17.20%)recurred after surgery,and 207 cases(82.80%)had no recurrence.The proportion of patients with recurrence of pituitary tumors whose length diameter of tumor≥10 mm,the degree of tumor resection was subtotal/partial resection,positive endothelial cell specific molecule-1(ESM-1)and proliferating cell nuclear antigen marker(Ki-67)index≥3% were higher than those of patients without recurrence(χ^(2)=33.221,31.436,10.973,15.644,P<0.05).Logistic regression analysis showed that tumor long diameter≥10 mm OR=5.675,P<0.05,tumor subtotal/partial resection OR=4.743,P<0.05,tissue ESM-1 positive OR=2.649,P<0.05,tissue Ki-67 index≥3% OR=3.398,P<0.05.Conclusions The maximum diameter of the tumor≥10 mm,the degree of subtotal/partial resection,the positive expression of ESM-1 in the tissue and the tissue Ki-67 index≥3% are the influencing factors of postoperative recurrence in patients with pituitary adenoma.