垂体瘤术后视野改善的时程特征及改善程度的影响因素

doi:10.3760/cma.j.issn.1674-845X.2018.07.003.

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目的：通过对垂体瘤患者进行术前及术后不同时间点中心静态视野的定量分析，来探讨经鼻蝶垂体瘤切除术后患者视野改善时程的特征，以及术后视野改善程度的影响因素。方法：回顾性系列病例研究。收集2013 年1 月至2016 年2 月在复旦大学附属上海市第五人民医院行经鼻蝶垂体瘤切除术且术前有视野缺损的垂体瘤患者110 例（212 眼），对其中在术后1 周复查视野有改善且术后3、6、12 个月时随访资料完整的30 例患者（45 眼）视野改善的时程特征进行分析。采用平均缺损（MD）定量分析视野。对各影响因素先进行单因素分析，再进行多因素Logistic回归分析。结果：随访资料完整的30例患者视野在术后1周时改善最为明显，而后随时间推移视野改善程度逐渐趋于平缓，其中有1例患者在术后12个月时出现垂体瘤复发。110例患者手术后1周视野正常、改善、无改善者最佳矫正视力（BCVA）、视野MD绝对值、全颞上象限视野缺损、视交叉压迫以及肿瘤最大径的差异有统计学意义（F=17.025，P <0.001；F=37.580，P < 0.001；χ2=17.459，P < 0.001；χ2=11.296，P=0.004；F=13.197，P < 0.001）；多因素Logistic回归分析显示术前BCVA（β=2.241，P=0.011，OR=9.406）、术前视野MD绝对值（β=0.195，P < 0.001，OR=1.215）、术前全颞上象限视野缺损（β=1.614，P=0.002，OR=5.024）、肿瘤最大径（β=0.512，P=0.023，OR=1.668）为影响术后视野改善程度的相对独立的影响因素。结论：经鼻蝶垂体瘤切除术后患者视野在术后1 周时改善最为迅速。术前BCVA、术前视野MD绝对值、术前全颞上象限视野缺损和肿瘤最大径为影响垂体瘤患者术后视野改善程度的相对独立影响因素。

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关键词 ：视野缺损, 垂体瘤, 经鼻蝶垂体瘤切除术, 时程特征

Abstract：

Objective: To analyze the time-dependent characteristics and possible prognostic factors for postoperative visual field improvement in patients after undergoing endonasal transsphenoidal pituitary tumor resection surgery. Methods: This retrospective case series study included 110 patients (212 eyes) who with visual
field defect underwent endonasal transsphenoidal pituitary tumor resection at the Fifth People's Hospital of Shanghai Fudan University between January 2013 and February 2016. Preoperative scans of the pituitary Time-Dependent Characteristics and Prognostic Factors of Visual Field Improvement in Patients after Endonasal Transsphenoidal Pituitary Tumor Resection were made by computed tomography or magnetic imaging resonsance. Preoperative eye examinations
included visual acuity, refraction, slit-lamp examination, fundus examination, intraocular pressure measurement, and central static visual field perimetry with a Humphrey-750i perimeter. Visual fields were measured again 1 week after surgery. Thirty patients (45 eyes) with visual field improvement and complete 3, 6, and 12 months follow-up data were analyzed for visual field improvement tendency. The mean deviation (MD) was used to quantify the visual field defect. Univariate analysis and multivariate logistic regression analysis for the prognostic factors of postoperative visual field improvement were carried out with SPSS 24.0 statistical software. Results: In the 30 patients with complete follow-up data, there was significant improvement in the postoperative visual field at 1 week after surgery, but the rate of improvement gradually declined over time. One patient experienced a pituitary tumor recurrence 12 months after surgery.There were significant differences in preoperative best corrected visual acuities (F=17.025, P < 0.001),preoperative MD absolute values (F=37.580, P < 0.001), preoperative full superotemporal quadrant visual field defects (χ2=17.459, P < 0.001), optic chiasm compressions (χ2=11.296, P=0.004), and maximum tumor diameters (F=13.197, P < 0.001) among the normal, improved, and unimproved postoperative visual field groups. Multivariate logistic regression analysis indicated that preoperative best corrected visual acuity (BCVA) (β=2.241, P=0.011, OR=9.406), preoperative MD absolute value (β=0.195, P < 0.001, OR=1.215), preoperative full superotemporal quadrant visual field defect (β=1.614, P=0.002, OR=5.024), and the maximum tumor diameter (β=0.512, P=0.023, OR=1.668) were the relatively independent prognostic factors for postoperative visual field improvement. Conclusions: After endonasal transsphenoidal pituitary tumor resection surgery, the visual field improvement was greatest at 1 week. Preoperative BCVA, preoperative MD absolute value, preoperative full superotemporal quadrant visual field defect, and the maximum tumor diameter were the relatively independent prognostic factors for postoperative visual field improvement.

Key words： visual field defect pituitary tumor endonasal transsphenoidal pituitary tumor resection time-dependent characteristics

收稿日期: 2018-02-01

基金资助:

上海市闵行区卫生和计划生育委员会科研课题资助（2012MW05）；复旦大学附属上海市第五人民医院院级课题资助（2010WYYJ06）

通讯作者: 于晓彦（ORCID：0000-0002-1984-3521），Email：yuxiaoyan306@126.com

引用本文:

于晓彦,朱皓皓,廖宇洁,金轶平. 垂体瘤术后视野改善的时程特征及改善程度的影响因素[J]. 中华眼视光学与视觉科学杂志, 2018, 20(7): 400-405. Xiaoyan Yu, Haohao Zhu, Yujie Liao, Yiping Jin. . Chinese Journal of Optometry Ophthalmology and Visual science, 2018, 20(7): 400-405. DOI: 10.3760/cma.j.issn.1674-845X.2018.07.003.

链接本文:

https://www.cjoovs.com/CN/10.3760/cma.j.issn.1674-845X.2018.07.003. 或 https://www.cjoovs.com/CN/Y2018/V20/I7/400

[1]	王淑静, 赵爱红, 李世洋. 垂体瘤患者眼部表现临床分析.国际眼科杂志, 2009, 9(10): 1993-1994. DOI: 10.3969/j.issn.1672-5123.2009.10.051.
[2]	牟晓燕, 李弘, 苏静, 等. 鞍区肿瘤患者的视野情况分析.国际眼科杂志, 2013, 13(3): 592-593. DOI: 10.3980/j.issn.1672-5123.2013.03.53.
[3]	张蔚, 李惠玲, 李波, 等. 垂体瘤患者神经眼科学检查分析72例. 眼科新进展, 2013, 33(02): 178-181.
[4]	彭蒙蒙, 梁琳琅, 邢雪, 等. 垂体瘤509 例临床特点及术后长期随访分析. 中国实用内科杂志, 2014, 34(5): 489-491. DOI:10.7504/nk2014040503.
[5]	Neil RM, Nancy JN, Valerier B, et al. Walsh and Hoyt精编临床神经眼科学. 张晓君, 魏文斌, 主译. 北京: 科学出版社, 2009:246.
[3]	张蔚, 李惠玲, 李波, 等. 垂体瘤患者神经眼科学检查分析72例. 眼科新进展, 2013, 33(02): 178-181.
[4]	彭蒙蒙, 梁琳琅, 邢雪, 等. 垂体瘤509 例临床特点及术后长期随访分析. 中国实用内科杂志, 2014, 34(5): 489-491. DOI:10.7504/nk2014040503.
[6]	Ogra S, Nichols AD, Stylli S, et al. Visual acuity and patternof visual field loss at presentation in pituitary adenoma. J Clin Neurosci, 2014, 21(5): 735-740. DOI: 10.1016/j.jocn.2014.01.005.
[7]	赵堪兴, 杨培增. 眼科学. 7 版, 北京: 人民卫生出版社, 2011:224.
[5]	Neil RM, Nancy JN, Valerier B, et al. Walsh and Hoyt精编临床神经眼科学. 张晓君, 魏文斌, 主译. 北京: 科学出版社, 2009:246.
[8]	王敏, 孟小红, 冉黎等. 39 例垂体瘤视野的改变规律. 临床眼科杂志, 2013, 21(6): 61-62. DOI: 10.3969/j.issn.1006-8422.2013.01.019.
[6]	Ogra S, Nichols AD, Stylli S, et al. Visual acuity and patternof visual field loss at presentation in pituitary adenoma. J Clin Neurosci, 2014, 21(5): 735-740. DOI: 10.1016/j.jocn.2014.01.005.
[7]	赵堪兴, 杨培增. 眼科学. 7 版, 北京: 人民卫生出版社, 2011:224.
[9]	王忠诚. 王忠诚神经外科学. 湖北: 湖北科学技术出版社,2004: 620-651.
[8]	王敏, 孟小红, 冉黎等. 39 例垂体瘤视野的改变规律. 临床眼科杂志, 2013, 21(6): 61-62. DOI: 10.3969/j.issn.1006-8422.2013.01.019.
[10]	祖朝辉, 王颖, 阚志生, 等. 垂体瘤MRI影像学特征与视功能障碍. 中华神经外科杂志, 2009, 29(8): 734-737. DOI: 10.3760/cma.j.issn.1001-2346.2009.08.025.
[11]	Okamoto Y, Okamoto F, Yamada S, et al. Vision-related quality of life after transsphenoidal surgery for pituitary adenoma. Invest Ophthalmol Vis Sci, 2010, 51(7): 3405-3410. DOI:
[9]	王忠诚. 王忠诚神经外科学. 湖北: 湖北科学技术出版社,2004: 620-651.
[10]	祖朝辉, 王颖, 阚志生, 等. 垂体瘤MRI影像学特征与视功能障碍. 中华神经外科杂志, 2009, 29(8): 734-737. DOI: 10.3760/cma.j.issn.1001-2346.2009.08.025.
10	1167/iovs.09-3763.
[12]	沈旻倩, 叶纹, 张宇燕, 等. 垂体瘤169例患者视野分析. 中华眼科杂志, 2009, 45(12): 1074-1079. DOI: 10.3760/cma.j.issn.0412-4081.2009.12.005.
[11]	Okamoto Y, Okamoto F, Yamada S, et al. Vision-related quality of life after transsphenoidal surgery for pituitary adenoma. Invest Ophthalmol Vis Sci, 2010, 51(7): 3405-3410. DOI:
[13]	Lee JP, Park IW, Chung YS. The volume of tumor mass and visual field defect in patients with pituitary macroadenoma. Korean J Ophthalmol, 2011, 25(1): 37-41. DOI: 10.3341/kjo.
10	1167/iovs.09-3763.
[12]	沈旻倩, 叶纹, 张宇燕, 等. 垂体瘤169例患者视野分析. 中华眼科杂志, 2009, 45(12): 1074-1079. DOI: 10.3760/cma.j.issn.0412-4081.2009.12.005.
[13]	Lee JP, Park IW, Chung YS. The volume of tumor mass and visual field defect in patients with pituitary macroadenoma. Korean J Ophthalmol, 2011, 25(1): 37-41. DOI: 10.3341/kjo.
20	11.25.1.37.
[14]	陶奕瑾, 赵灿, 张扬, 等. 垂体瘤患者视野缺损和视功能特点.中华眼视光学与视觉科学杂志, 2014, 16(11): 659-662. DOI:10.3760/cma.j.issn.1674-845X.2014.11.005.
[15]	Kerrison JB, Lynn MJ, Baer CA, et al．Stages of improvementin visual fields after pituitary tumor resection. Am J Ophthalmol,2000, 130(6): 813-820. DOI: 10.1016/S0002-9394(00)00539-0.
20	11.25.1.37.
[14]	陶奕瑾, 赵灿, 张扬, 等. 垂体瘤患者视野缺损和视功能特点.中华眼视光学与视觉科学杂志, 2014, 16(11): 659-662. DOI:10.3760/cma.j.issn.1674-845X.2014.11.005.
[15]	Kerrison JB, Lynn MJ, Baer CA, et al．Stages of improvementin visual fields after pituitary tumor resection. Am J Ophthalmol,2000, 130(6): 813-820. DOI: 10.1016/S0002-9394(00)00539-0.
[16]	Gnanalingham KK, Bhattacharjee S, Pennington R, et al. The time course of visual field recovery following transphenoidal surgery for pituitary adenomas: Predictive factors for a good
	outcome. J Neurol Neurosurg Psychiatry, 2005, 76(3): 415-419.DOI: 10.1136/jnnp.2004.035576.
[17]	张伟, 罗坤, 周凯, 等. 内镜经鼻蝶垂体瘤切除术后患者视野的恢复及影响因素分析. 医学综述, 2014, 20(12): 2239-2240.DOI: 10.3969/j.issn.1006-2084.2014.12.049.
[18]	邹文军, 武志峰, 严海燕, 等. 光学相干断层扫描在判断垂体瘤患者术后视功能预后中的应用. 中华眼视光学与视觉科学杂志, 2010, 12(3): 224-228. DOI: 10.3760/cma.j.issn.1674-
[16]	Gnanalingham KK, Bhattacharjee S, Pennington R, et al. The time course of visual field recovery following transphenoidal surgery for pituitary adenomas: Predictive factors for a good
84	5X.2010.03.017.
	outcome. J Neurol Neurosurg Psychiatry, 2005, 76(3): 415-419.DOI: 10.1136/jnnp.2004.035576.
[19]	Müslüman AM, Cansever T, Yilmaz A, et al. Surgical results oflarge and giant pituitary adenomas with special considerationof ophthalmologic outcomes. World Neurosurg, 2011, 76(1-2):141-148. DOI: 10.1016/j.wneu.2011.02.009.
[17]	张伟, 罗坤, 周凯, 等. 内镜经鼻蝶垂体瘤切除术后患者视野的恢复及影响因素分析. 医学综述, 2014, 20(12): 2239-2240.DOI: 10.3969/j.issn.1006-2084.2014.12.049.
[18]	邹文军, 武志峰, 严海燕, 等. 光学相干断层扫描在判断垂体瘤患者术后视功能预后中的应用. 中华眼视光学与视觉科学杂志, 2010, 12(3): 224-228. DOI: 10.3760/cma.j.issn.1674-
[20]	Barzaghi LR, Medone M, Losa M, et al. Prognostic factors ofvisual field improvement after trans-sphenoidal approach for pituitary macroadenomas: review of the literature and analysis
84	5X.2010.03.017.
	by quantitative method. Neurosurg Rev, 2012, 35(3): 369-379.DOI: 10.1007/s10143-011-0365-y.
[19]	Müslüman AM, Cansever T, Yilmaz A, et al. Surgical results oflarge and giant pituitary adenomas with special considerationof ophthalmologic outcomes. World Neurosurg, 2011, 76(1-2):141-148. DOI: 10.1016/j.wneu.2011.02.009.
[21]	Pawlikowski M, Kunert-Radek J, Radek M. Plurihormonality ofpituitary adenomas in light of immunohistochemical studies. Pol J Endocrinol, 2010, 61 (1): 63-66.
[20]	Barzaghi LR, Medone M, Losa M, et al. Prognostic factors ofvisual field improvement after trans-sphenoidal approach for pituitary macroadenomas: review of the literature and analysis
	by quantitative method. Neurosurg Rev, 2012, 35(3): 369-379.DOI: 10.1007/s10143-011-0365-y.
[21]	Pawlikowski M, Kunert-Radek J, Radek M. Plurihormonality ofpituitary adenomas in light of immunohistochemical studies. Pol J Endocrinol, 2010, 61 (1): 63-66.