發(fā)布時間：2018-03-11 03:24

  本文選題：垂體瘤　切入點(diǎn)：尿崩癥　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景垂體腺瘤是神經(jīng)外科常見的一種神經(jīng)內(nèi)分泌性腫瘤,其主要源于腺垂體,但也可起源于神經(jīng)垂體及顱咽管殘余細(xì)胞[1]。據(jù)最新調(diào)查顯示其患病率為7.5~15/10萬人,占顱內(nèi)腫瘤的8%~15%[2]。當(dāng)前,垂體瘤的治療是以手術(shù)切除為主,同時聯(lián)合藥物及放射治療為輔助方式的綜合治療方法。17世紀(jì)80年代,Horsley年采取經(jīng)顱入路,完成了世界上首臺垂體瘤切除術(shù)。經(jīng)蝶入路由Schloffe于18世紀(jì)初始創(chuàng),但因當(dāng)時照明設(shè)備、手術(shù)器械不佳,導(dǎo)致術(shù)中腫瘤暴露不良,止血困難及術(shù)后并發(fā)癥較多等原因,致使該術(shù)式并未得以廣泛應(yīng)用。20世紀(jì)60年代手術(shù)顯微鏡應(yīng)用到臨床,Hardy于1967年首次將其應(yīng)用到經(jīng)蝶垂體瘤切除術(shù),憑借其放大及良好照明的優(yōu)點(diǎn),大大提高了手術(shù)效果。經(jīng)蝶垂體瘤切除術(shù)因其腫瘤切除率高、創(chuàng)傷小、術(shù)后患者反應(yīng)輕,并發(fā)癥少,恢復(fù)快,患者住院周期短等優(yōu)勢,目前較經(jīng)顱垂體瘤切除術(shù)應(yīng)用更廣泛。但一些向鞍上及鞍旁發(fā)展的腫瘤,依然需要通過經(jīng)顱手術(shù)切除。垂體瘤術(shù)后并發(fā)癥主要包括:鞍內(nèi)出血、鼻出血、腦脊液漏、顱內(nèi)感染、尿崩癥、垂體功能減退、眼肌麻痹、鼻中隔穿孔等。而尿崩癥是垂體瘤術(shù)后最常見的并發(fā)癥之一。研究目的總結(jié)大連醫(yī)科大學(xué)附屬第二醫(yī)院2009~2017年期間120例行垂體瘤切除術(shù)患者的病歷資料,分析垂體瘤術(shù)后尿崩癥與年齡、性別、腫瘤大小、腫瘤內(nèi)分泌功能類型、腫瘤侵襲性、腫瘤生長方向(是否突破鞍隔)、手術(shù)方式以及腫瘤切除程度等因素的關(guān)系,探討垂體瘤術(shù)后尿崩癥的發(fā)病機(jī)理及診治方法。研究方法運(yùn)用SPSS19.0統(tǒng)計(jì)分析軟件進(jìn)行統(tǒng)計(jì)分析,計(jì)量資料采用t檢驗(yàn),計(jì)數(shù)資料采用X2檢驗(yàn),首先進(jìn)行單因素分析,分析不同因素與垂體瘤術(shù)后尿崩癥的相關(guān)性,將單因素分析中存在統(tǒng)計(jì)學(xué)差異的指標(biāo)再進(jìn)行多因素Logistic分析,p≤0.05時差異有統(tǒng)計(jì)學(xué)意義。研究結(jié)果120例垂體瘤手術(shù)患者中,術(shù)后出現(xiàn)尿崩癥37例,尿崩癥發(fā)生率為30.8%。經(jīng)過統(tǒng)計(jì)分析結(jié)果顯示:腫瘤大小是術(shù)后尿崩癥的獨(dú)立影響因素(W=5.742P=0.017 OR=10.894)。腫瘤生長方式是術(shù)后尿崩癥的獨(dú)立影響因素(W=4.351P=0.026 OR=0.035)。尿崩癥發(fā)生率,大腺瘤大腺瘤為腺瘤,突破鞍隔向鞍上侵犯的垂體瘤較未突破鞍隔者更易發(fā)生尿崩。而尿崩癥的發(fā)生與年齡、性別、腫瘤內(nèi)分泌功能類型、腫瘤侵襲性、手術(shù)方式及腫瘤切除程度無關(guān)(P0.05)。結(jié)論1.垂體瘤術(shù)后尿崩癥的發(fā)生與腫瘤大小、腫瘤生長方向(突破鞍隔)有關(guān),而與年齡、性別、腫瘤內(nèi)分泌功能類型、腫瘤侵襲性、手術(shù)方式及腫瘤切除程度無關(guān)。尿崩發(fā)生率大腺瘤大腺瘤為腺瘤,突破鞍隔向鞍上侵犯的垂體瘤較未突破鞍隔者更易發(fā)生尿崩癥。2.術(shù)中注意保護(hù)下丘腦、垂體柄、垂體后葉組織及其血供,術(shù)后及時準(zhǔn)確的診斷和治療,是防治垂體腺瘤術(shù)后尿崩癥的關(guān)鍵。
[Abstract]:Background pituitary adenoma is a common neuroendocrine tumor in neurosurgery. It is mainly derived from the pituitary gland, but also from the residual cells of the neurohypophysis and craniopharynx [1]. 8% of intracranial tumors [2] .At present, the main treatment of pituitary adenoma is surgical resection, combined with drugs and radiotherapy as a supplementary method. In 80s, Horsley adopted transcranial approach. The first pituitary adenectomy in the world was completed. Transsphenoidal Schloffe was first established in 18th century. However, due to poor lighting and surgical instruments at that time, the tumor was not well exposed during the operation, the hemostasis was difficult, and there were more complications after the operation. In 1967, Hardy first applied it to transsphenoidal pituitary adenoma resection, with its advantages of magnification and good illumination. The transsphenoidal pituitary adenectomy has the advantages of high resection rate, small trauma, light postoperative reaction, less complications, quick recovery, short hospitalization period, and so on. At present, it is more widely used than transcranial pituitary tumor resection. However, some tumors that develop to suprasellar and parasellar tumors still need to be resected through transcranial surgery. Postoperative complications of pituitary adenoma include: intraSellar hemorrhage, epistaxis, cerebrospinal fluid leakage, intracranial infection. Diabetes insipidus, hypophysis, ophthalmoplegia, Perforation of nasal septum, etc. Diabetes insipidus is one of the most common complications after pituitary adenoma. Objective to summarize the medical records of 120 patients undergoing pituitary adenectomy in the second affiliated Hospital of Dalian Medical University from 2009 to 2017. To analyze the relationship between diabetes insipidus and age, sex, tumor size, tumor endocrine function, tumor invasion, tumor growth direction (whether the tumor breaks through the saddle septum, the operation method and the degree of tumor excision, etc.). To explore the pathogenesis, diagnosis and treatment of diabetes insipidus after pituitary adenoma. Methods the statistical analysis was carried out by SPSS19.0 software, the measurement data were analyzed by t test, the count data by X2 test, and the single factor analysis was carried out. The correlation between different factors and diabetes insipidus after pituitary adenoma operation was analyzed. The multivariate Logistic analysis showed that there were significant differences when the single factor analysis was statistically different in patients with pituitary adenoma surgery (P < 0. 05). There were 37 cases of diabetes insipidus after operation, the incidence rate of diabetes insipidus was 30.8. The results of statistical analysis showed that tumor size was the independent influencing factor of postoperative diabetes insipidus. Tumor growth pattern was the independent influencing factor of postoperative diabetes insipidus. Macroadenoma and macroadenoma is a adenoma. Pituitary tumors invading through the Sellar septum are more prone to urinary collapse than those without Sellar septum. The occurrence of diabetes insipidus is associated with age, sex, type of endocrine function, invasiveness of tumor, age, sex, type of endocrine function, invasiveness of tumor. Conclusion 1. The incidence of diabetes insipidus after pituitary adenoma surgery is related to tumor size, tumor growth direction (breakthrough of Sellar septum), but to age, sex, type of endocrine function of tumor, invasion of tumor. 2. The incidence of large adenoma was adenoma. The pituitary tumor invading through the Sellar septum was more likely to develop diabetes insipidus than those without Sellar septum. 2. During the operation, attention should be paid to the protection of hypothalamus and pituitary stalk. The diagnosis and treatment of pituitary posterior lobe tissue and its blood supply are the key to prevent and cure postoperative diabetes insipidus.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R736.4

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