神经内镜辅助下经鼻腔–蝶窦切除静默性生长 激素型垂体瘤的临床特征分析

Clinical Characteristics Analysis of Silent Growth Hormone-Type Pituitary Tumors Resected via Nasal-Cavernous Sinus Approach with Neuroendoscopic Assistance

摘要: 目的：比较神经内镜辅助下经鼻蝶手术治疗的静默性生长激素(GH)型垂体腺瘤与普通GH型垂体腺瘤的临床病理特征，并分析其术后复发的影响因素。方法：回顾性纳入90例GH型垂体腺瘤患者，其中静默性GH型31例，普通GH型59例。所有患者均接受神经内镜经鼻蝶手术。收集并比较两组患者的临床资料、肿瘤特征、手术疗效及随访信息，分析影响复发的相关因素。结果：静默性GH型垂体腺瘤患者术前血清GH水平显著低于普通型患者(4.3 ± 3.0 ng/mL vs 28.3 ± 12.5 ng/mL, P < 0.001)，但两组在肿瘤大小、Knosp分级、Ki-67指数等方面无显著差异(P > 0.05)。两组手术全切率及并发症发生率亦无统计学差异。在复发因素分析中，普通GH型垂体腺瘤的复发与多项临床病理参数无关；而静默性GH型垂体腺瘤的复发与肿瘤最大径更大(22.6 ± 5.3 mm vs 16.4 ± 7.3 mm, P = 0.039)和Ki-67指数更高(4.2 ± 2.2 vs 2.1 ± 1.1, P = 0.003)显著相关。结论：静默性GH型垂体腺瘤虽然缺乏典型临床表现，但其侵袭生长潜力与普通型相似，且术后复发与肿瘤体积大、Ki-67指数高密切相关。对于此类患者，应实施彻底的手术切除，并对具有高危因素者加强术后随访及考虑辅助治疗。

Abstract: Objective: To compare the clinical and pathological characteristics of silent growth hormone (GH)-type pituitary adenomas and ordinary GH-type pituitary adenomas treated with neuroendoscopic transsphenoidal surgery, and to analyze the influencing factors of postoperative recurrence. Methods: A total of 90 patients with GH type pituitary adenomas were retrospectively included, including 31 cases of silent GH type and 59 cases of ordinary GH type. All patients underwent neuroendoscopic transsphenoidal surgery. Clinical data, tumor characteristics, surgical efficacy, and follow-up information of the two groups were collected and compared. Relevant factors influencing recurrence were analyzed. Results: The preoperative serum GH level of patients with silent GH type pituitary adenomas was significantly lower than that of patients with the ordinary type (4.3 ± 3.0 ng/mL vs 28.3 ± 12.5 ng/mL, P < 0.001). However, there were no significant differences in tumor size, Knosp grade, and Ki-67 index between the two groups (P > 0.05). There were no statistically significant differences in the total resection rate and complication rate between the two groups. In the analysis of recurrence factors, the recurrence of ordinary GH type pituitary adenomas was not related to multiple clinical and pathological parameters. In contrast, the recurrence of silent GH type pituitary adenomas was significantly related to a larger maximum tumor diameter (22.6 ± 5.3 mm vs 16.4 ± 7.3 mm, P = 0.039) and a higher Ki-67 index (4.2 ± 2.2 vs 2.1 ± 1.1, P = 0.003). Conclusion: Although silent GH-type pituitary adenomas lack typical clinical manifestations, their invasive growth potential is similar to that of the ordinary type. Postoperative recurrence is closely associated with larger tumor size and a higher Ki-67 index. For such patients, complete surgical resection should be carried out, and postoperative follow-up should be enhanced for those with high-risk factors. Moreover, adjunctive therapy should be considered.