无功能性垂体巨大腺瘤卒中的特点及预后分析

目的:探讨无功能性垂体巨大腺瘤瘤内卒中的临床和影像学特点,及其对手术疗效和预后的影响。方法:回顾性分析我院自2012年1月至2015年12月收治的86例垂体卒中病例的临床资料。结果:出血性卒中组患者就诊时间较缺血性卒中组更及时(P0.001);梗阻性卒中组的垂体腺瘤侵袭范围更广(Hardy's分级:P=0.02;Knosp分级:P=0.002);出血性卒中形态更倾向于团块状聚集发生,而有不少缺血性卒中形态呈现多发/散点状分布(P=0.005);缺血性卒中易发生于鞍隔上区,而出血性卒中于鞍内较多见(P0.001);缺血性卒中组患者的术后视敏度改善情况优于出血性卒中组(P=0.028);缺血性卒中组术后并发症发生率低于出血性卒中组(P0.05)。结论:出血性垂体卒中就诊相对及时,及时手术治疗能获得较好的预后,但手术时需仔细辨别正常组织,防止术后并发症;缺血性卒中就诊时机较晚,侵袭范围广,但术后并发症相对较少。合理区分垂体卒中类型对于制定治疗方案及评价预后有一定的价值。

Analysis of the Characteristics and Prognosis of Apoplexy in Nonfunctioning Pituitary Macroadenoma

ABSTRACT Objective: To explore the clinical characteristics and imaging features of apoplexy in nonfunctioning pituitary macroadenoma and its impacts on the postoperative outcomes and prognosis. Methods: The clinical data of 86 patients with pituitary apoplexy admitted in our hospital from Jan 1, 2012, to December 31, 2015 were retrospectively analyzed. Results: The preoperative duration of patients'' symptoms of the hemorrhagic apoplexy (HA) group was shorter (P<0.001) than of the ischemic apoplexy (IA) group. The wider invasion of macroadenomas occurred in the IA group than that of the HA group (Hardy''s Classification, P=0.02; Knosp Classification, P=0.002). HA appeared generally as a single shape, while more IA presented with multiple/scattered shapes (P=0.005). It seemed to be more common that IA occurred in the suprasellar region and HA occurred in the intrasellar region (P<0.001). The patients'' improvement of visions in the IA group was better than those in the HA group (P=0.028), and there were fewer complications in the IA group than the HA group (P<0.05). Conclusion: Pituitary adenomas in the HA group could be operated in a timely manner in order to gain a good prognosis and the adenomas needed to be operated by distinguishing the normal gland in order to decrease postoperative complications. Pituitary adenoma with IA, accompanied by a later treatment, invaded the wider regions, but there could be fewer complications appeared than the HA group. It is, therefore, worthy of paying close attention to apoplectic types when making treatment protocols and assessing prognosis.