垂体神经内分泌肿瘤手术策略调整对治疗效果的改善作用分析:附3 504例报告

Analysis of the improvement of treatment effects by adjusting surgical strategies for pituitary neuroendocrine tumors:a report of 3504 cases

目的 分析垂体神经内分泌肿瘤(PitNETs)手术策略的调整对其治疗效果的改善作用.方法 回顾性分析2008年1月至2022年12月于首都医科大学附属北京天坛医院神经外科学中心接受手术治疗的3 504例PitNET患者的临床资料.期间结合文献报道和自主探索,对手术策略进行了调整.2008年1月至2016年12月收治的患者(A组)采用调整前的手术策略治疗,2017年1月至2022年12月收治的患者(B组)采用调整后的手术策略治疗.手术策略调整要点包括多维度分隔空间手术切除、功能性PitNETs的超范围切除以及个体化颅底重建.对比分析两组患者的手术治疗效果及术后并发症的发生情况.结果 A组患者共1 394例,B组共2 110例.B组的肿瘤全切除率[91.0%(1 920/2 110)对比73.4%(1 023/1 394)]、术后视力好转率[89.6%(509/568)对比69.0%(260/377)]均高于A组(均P<0.001),而术后脑脊液漏的发生率[0.5%(10/2 110)对比5.1%(71/1 394)]、术后颅内感染发生率[2.4%(50/2 110)对比4.2%(58/1 394)]、术后腰大池置管率[0.3%(6/2 110)对比3.6%(50/1 394)]均低于A组(均P<0.05).其中,功能性PitNET术后的生物学治愈率方面,A组患者低于B组[52.3%(203/388)对比83.6%(475/568),P<0.001].结论 PitNET手术策略的改进可明显提高手术治疗效果,并且能够减少相关并发症的发生.

Objective To analyze the effect of adjusting the surgical strategy of pituitary neuroendocrine tumors(PitNET)on improving the treatment effect.Methods The clinical data of 3504 PitNET patients who underwent surgical treatment at the Neurosurgery Center of Beijing Tiantan Hospital,Capital Medical University from January 2008 to December 2022 were retrospectively analyzed.During this period,the surgical strategy was adjusted based on literature reports and independent exploration.Patients admitted from January 2008 to December 2016(Group A)were treated with the pre-adjusted surgical strategy,and patients admitted from January 2017 to December 2022(Group B)were treated with the adjusted surgical strategy.The surgical treatment effects and postoperative complications of the two groups of patients were compared and analyzed.Results There were 1394 patients in group A and 2110 patients ingroup B.The total tumor resection rate of group B[91.0%(1920/2110)vs.73.4%(1023/1394)],and the postoperative visual acuity improvement rate[89.6%(509/568)vs.69.0%(260/377)]were higher than those in group A(both P<0.001),while the incidence of postoperative cerebrospinal fluid leakage[0.5%(10/2110)vs.5.1%(71/1394)],and the incidence of postoperative intracranial infection[2.4%(50/2110)vs.4.2%(58/1394)],and the postoperative lumbar catheterization rate[0.3%(6/2110)vs.3.6%(50/1394)]were lower than those in group A(all P<0.05).Among them,the biological cure rate of patients with functional PitNET in group A after surgery was lower than that in group B[52.3%(203/388)vs.83.6%(475/568),P<0.001].Conclusion Improvement of PitNET surgical strategy can significantly improve the effect of surgical treatment and reduce the occurrence of related complications.