鞍底骨窗大小对经鼻蝶入路垂体瘤切除术的影响分析

【摘要】目的探究鞍底骨窗大小对经鼻蝶入路垂体瘤切除术的影响。方法回顾性分析87例经鼻蝶入路手术治疗垂体瘤患者的临床资料，通过3D-Slicer软件计算标准化鞍底骨窗面积，根据标准化骨窗的大小分3组：小骨窗面积组，（60.97±3.80）mm2，n=29；中骨窗面积组，（71.00±2.37）mm2，n=28；大骨窗面积组，（80.83±2.07）mm2，n=30。对3组患者的临床资料采用多因素Logistic回归模型评估鞍底骨窗大小与经鼻蝶入路手术垂体瘤切除程度之间的关系。根据年龄、性别、手术方式、肿瘤大小、肿瘤质地、肿瘤Knosp分级、肿瘤形态进行交互和亚组分析。结果多因素Logistic回归分析显示，在3组的比较中，标准化鞍底骨窗大小与经鼻蝶入路垂体瘤切除程度显著相关（经调整后OR,4.18；95% CI,1.73~10.1）。在亚组分析中标准化骨窗大小与垂体瘤切除程度的相关性与多因素Logistic回归分析一致（OR,1.16；95% CI,1.06~1.27），表明鞍底骨窗大小与垂体瘤切除程度的关联独立于影响切除程度的其他因素。结论鞍底骨窗面积大小是影响经鼻蝶入路垂体瘤切除程度的独立影响因素，鞍底骨窗大小的不足，是导致术后肿瘤残留的重要因素之一。对于垂体大腺瘤，Knosp分级Ⅲ- Ⅳ级、肿瘤质地韧的垂体瘤，需要做大面积鞍底骨窗，有利于肿瘤全切。

Abstract: ObjectiveTo explore the size of sellar floor window in pituitary adenoma resection by transsphenoidal approach. MethodsThe clinical data of 87 patients with pituitary adenomas treated by transnasal transsphenoidal approach were analyzed retrospectively. The standardized sellar floor bone window area was calculated by 3D-slicer software. According to the size of the standardized bone windows, it was divided into three groups: small bone window group, (60.97±3.80)mm2, n=29, middle bone window group, (71.00±2.37)mm2, n=28, large bone window group, (80.83±2.07)mm2, n=30. Multivariate logistic regression model was used to evaluate the relationship between the size of sellar bone window and the extent of pituitary adenoma resection by transnasal transsphenoidal approach. Interaction and subgroup analysis were performed according to age, gender, operation mode, tumor size, tumor texture, tumor Knosp grading and tumor morphology. ResultsMultivariate logistic regression analysis revealed that the extent of tumor resection was significantly associated with standardized size of sellar floor opening in endonasal transsphenoidal surgery(adjusted OR,4.18,95% CI,1.73-10.1). In subgroup analysis, the association between standardized size of sellar floor opening and extent of tumor resection was consistent with multivariate logistic regression analysis(OR,1.16, 95% CI,1.06-1.27). Interaction analysis showed that there was no interaction between them, indicating that the association between standardized size of sellar floor opening and extent of tumor resection was independent of other factors affecting resection. ConclusionThe size of sellar floor bone window is an independent factor affecting the degree of pituitary tumor resection through nasal transsphenoidal approach. The insufficient size of sellar floor bone window is one of the important factors leading to postoperative tumor residue. When there is pituitary macroadenoma, knosp III-IV grade and the tumor is hard, it is recommended to make a larger sellar bone window, which is helpful for total resection of the tumor.