Analysis Of Hormone Changes And Influencing Factors In Transsphenoidal Resection Of Functional Pituitary Adenomas

Objective:To investigate the changes of hormones after neuroendoscopic and transsphenoidal functional pituitary adenomas resection,and to evaluate the effect of the two surgical approaches.The perioperative and intraoperative clinical datas were further analyzed,so as to explore the affecting factors of hormone changes after functional pituitary adenoma resection,and to provide a better theoretical basis for the functional pituitary adenoma resection.Methods:The clinical datas of 139 patients with transsphenoidal functional pituitary adenoma resection in Tianjin Huanhu Hospital from October 2016 to October 2018 were retrospectively analyzed.According to different surgical approaches,the patients were divided into neuroendoscopy group(group A)and microscopy group(group B).The clinical datas of patients in the two groups(such as sex,age,clinical manifestation,preoperative pituitary hormone level,intraoperative condition,postoperative pituitary hormone level and symptom improvement,etc)were analyzed using the SPSS 25.0 software.Moreover,the surgical effects of neuroendoscopy and microscopy were compared.According to whether the pituitary hormone returns to normal levels after operation,the patients were divided into the two groups: return to normal group and non-return to normal group.Single-factor and multi-factor logistic regression were used to identify the relationship between various factors(such as sex,age,course of disease,invasiveness,tumor texture,cystic change and/or stroke,tumor size,tumor type,operation method,degree of resection,etc)and changes of postoperative hormones,so as to provide the theoretical basis for the clinical diagnosis and treatment of functional pituitary adenoma.Results:Among 139 patients,there were 74 cases in group A(53.2%)and 65 cases in group B(46.8%).There was significant difference in the degree of tumor resection between the two groups.The resection rate of tumors in group A was higher than that of group B(P=0.025).There was difference in the postoperative hormone changes between the two groups.The cure rate of patients in group A was significantly better than that of group B(P=0.025).The postoperative hormone level of 44.6% of patients in group B was decreased by more than 50%,but the patients were not cured.Wherein,the cure rates of prolactin(PRL)adenoma and growth hormone(GH)adenoma of patients showed statistically significant difference between group A and group B(P=0.04;P=0.034).There was no significant difference in the cure rate of Adrenocorticotropic Hormone(ACTH)adenoma between the two groups.Postoperative complications of patients in group A were less than those of group B(P=0.029).The cure rate of tumor with cavernous sinus invasiveness of patients in group A was significantly superior to that of group B(P=0.009).Among 139 patients,83 cases recovered to normal hormone levels after operation and the cure rate was 59.7%.Logistic regression showed that invasiveness of tumors,cystic change and/or stroke,surgical methods and resection degree were the factors influencing the changes of postoperative hormones(P<0.05),while the sex,age,course of disease,history of diabetes,history of hypertension and size of tumors were not significantly correlated with the changes of postoperative hormone(P>0.05).Conclusion:Both two approaches can effectively improve the postoperative hormone levels of patients with functional pituitary adenoma.However,the neuroendoscopy approach has a more obvious improving effect compared with the microscopy approach,especially for the tumor with cavernous sinus invasiveness.The resection rate of tumors under neuroendoscopy is higher than that of under microscopy,and the complications are less.The postoperative hormones in patients with functional pituitary adenomas are affected by many factors,including invasiveness of tumors,cystic change and/or stroke,surgical methods and resection degree.Perfection of preoperative examinations,comprehensive evaluation of tumors and intraoperative resection as much as possible can improve the prognosis of patients.