Clinical Study On The Postoperative Effect Of Surgical Treatment For Invasive Pituitary Tumor

Objective:With the development of medical imaging,endocrinology and neurosurgery,the number of invasive pituitary adenoma is increasing.At present,the diagnosis of invasive pituitary adenoma is not difficult,but there is still no uniform and definite treatment plan,which is still a difficult problem in the field of surgery.The purpose of this study was to investigate the clinical effect of surgical resection of invasive pituitary adenoma.It provides a new idea and method for the treatment of invasive pituitary adenoma.Methods:Data of clinical symptoms,imaging manifestations,surgical approach,prognosis,postoperative complications and recurrence rate of52 cases of invasive pituitary adenoma treated and operated in our department from June 2016 to June 2018 were retrospectively analyzed,all data adopt SPSS24.0 software for processing,and the advantages and disadvantages of each surgical approach were compared.Results:In this study,17 cases of prolactin-type pituitary adenoma,15 cases of growth hormone adenoma,14 cases of nonfunctional adenoma,and 6cases of other hormone-promoting adenoma were included.Among them,12 cases were nasal transsphenoidal approach and 3 cases(25.0%)were total excision.There were 14 cases of pterional approach and 10 cases of total excision(71.4%).There were 11 cases of subfrontal approach and 8 cases of total excision(72.7%).There were 8 cases of subfrontal-pterional approach and 7 cases of total excision(87.5%).Subfrontal combined ventricle access was performed in 7 cases and total resection was performed in 6 cases(85.7%).The nasal transsphenoidal approach,the pterional approach,the subfrontal approach,the combined subfrontal-pterional approach and the combined subfrontal ventricular approach were divided into three groups,namely the nasal transsphenoidal approach,the single approach and the combined approach.The total tumor resection rate was 25.0% in the nasal transsphenoidal group,72.0% in the single approach group,and 86.7% in the combined approach group.After statistical analysis,P=0.015 was statistically significant,indicating that there were differences among the three groups.The apparent remission rate of postoperative symptoms was 41.7% in the nasal transsphenoidal group,83.2% in the single approach group,and 81.1% in the combined approach group.In terms of postoperative complications,the single approach and combined approach were more serious than the nasal transsphenoidal approach group.The postoperative follow-up period was 3-24 months,duringwhich the recurrence rate of the nasal transsphenoidal group was 50.0%,that of the single approach group was 24.0%,and that of the combined approach group was 6.7%.After statistical analysis,P = 0.035,indicating that there were differences among the three groups.Conclusion:(1)The total tumor resection rate and recurrence rate of the nasal transsphenoidal approach were worse than that of the single approach and the combined approach,but the injuries were small,postoperative symptoms were mild,and it was easy to be accepted.(2)Invasive pituitary adenoma often invades surrounding tissues.Nasal transsphenoidal approach is difficult to completely resect the tumor due to various limitations,while craniotomy has a better field of vision and a higher rate of total resection,which is generally regarded as the first choice for treatment.(3)When the tumor invasions into the third ventricle or lateral ventricle,the combined approach can be preferred,and the resection rate of the tumor in this area is better than that of the single approach.When a large tumor invades the frontal region and temporal region,the combined approach can create a broader surgical field of vision and facilitate the total resection of the tumor.However,all approaches should be carried out on the premise of ensuring the patient's life and minimizing postoperative complications.