经鼻神经内镜切除无功能垂体瘤术后女性月经紊乱发生的危险因素研究

Study on the risk factors for menstrual disorders in women after transnasal neuroendoscopic resection of non-functional pituitary tumors

摘要

目的 探讨经鼻神经内镜切除无功能垂体瘤术后女性月经紊乱发生的危险因素。方法 选取2022年2月至2024年2月在西安交通大学第一附属医院进行经鼻神经内镜切除无功能垂体瘤的女性患者93例为研究对象,所有患者术前均未发生月经紊乱、瘤体直径＞1cm.按术后是否发生月经紊乱将患者分为月经紊乱组(9例)与月经正常组(84例).分析患者的一般临床特征、围术期指标、月经紊乱发生情况,通过多因素Logistic回归分析术后女性月经紊乱发生的危险因素。结果 月经正常组与月经紊乱组患者的年龄及文化程度、肿瘤直径、病程、居住地、婚姻情况、母亲月经紊乱占比比较,差异均无统计学意义(P＞0.05).月经正常组与月经紊乱组患者的术中出血量、手术用时、住院时间,以及手术切除效果、视野缺损、辅助治疗占比比较,差异均无统计学意义(P＞0.05);与月经正常组患者比较,月经紊乱组患者术前及术后三碘甲状腺原氨酸(T₃)、游离甲状腺素(FT₄)、促卵泡激素(FSH)、黄体生成素(LH)、雌二醇(E₂)水平均降低,术前及术后促甲状腺激素(TSH)、泌乳素(PRL)水平均升高,差异均有统计学意义(t值介于4.618~20.568之间,P＜0.05).多因素Logistic回归分析显示,术前及术后TSH、PRL为经鼻神经内镜切除无功能垂体瘤术后女性发生月经紊乱的危险因素(OR值介于4.899~5.349之间,P＜0.05);术前及术后T₃、FT₄、FSH、LH、E₂为术后女性发生月经紊乱的保护因素(OR值介于0.205~0.390之间,P＜0.05)。结论 无功能垂体瘤女性患者通过经鼻神经内镜切除术治疗后发生月经紊乱与多种因素有关,包括术前及术后的T₃、TSH、FT₄、FSH、LH、PRL及E₂,临床可采取针对性措施来降低女性月经紊乱的发生率.

Abstract

Objective To investigate the risk factors of menstrual disorders in women after transnasal neuroendoscopic resection of non-functional pituitary tumors. Methods A total of 93 female patients who underwent transnasal neuroendoscopic resection of nonfunctioning pituitary tumors in the First Affiliated Hospital of Xi′an Jiaotong University from February 2022 to February 2024 were selected as the research objects. All patients had no menstrual disorder before operation and the diameter of tumors was ＞1cm. The patients were divided into the menstrual disorder group (9 cases) and the normal menstrual group (84 cases) according to whether menstrual disorders occurred after the operation. The general clinical characteristics of the patients, perioperative indicators, and the occurrence of menstrual disorders were analyzed. The risk factors for menstrual disorders in postoperative women were analyzed through multivariate logistic regression. Results There were no statistically significant differences in age and educational level, tumor diameter, disease duration, place of residence, marital status, and the proportion of mothers with menstrual disorders between the normal menstruation group and the menstrual disorder group (P＞0.05). There were no statistically significant differences in intraoperative blood loss, operation time, hospital stay, surgical resection effect, visual field defect, and the proportion of adjuvant therapy between the patients in the normal menstruation group and the menstrual disorder group (P＞0.05). Compared with patients in the normal menstruation group, the levels of triiodothyronine (T₃), free thyroxine (FT₄), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E₂) in the menstrual disorder group decreased before and after the operation, while the levels of thyroid-stimulating hormone (TSH) and prolactin (PRL) increased before and after the operation. The differences were all statistically significant (t ranged from 4.618 to 20.568, P＜0.05). Multivariate Logistic regression analysis showed that preoperative TSH, PRL and postoperative TSH, PRL were risk factors for menstrual disorders in women with nonfunctional pituitary adenoma after transnasal endoscopic resection (OR values ranged from 4.899 to 5.349, P＜0.05), while preoperative T₃, FT₄, FSH, LH, E₂ and postoperative T₃, FT₄, FSH, LH, E₂ were protective factors (OR values ranged from 0.205 to 0.390, P＜0.05). Conclusion Menstrual disorders in female patients with non-functional pituitary tumors treated by transnasal neuroendoscopic resection are related to multiple factors, including T₃, TSH, FT₄, FSH, LH, PRL and E₂ before and after the operation. Targeted measures can be taken clinically to reduce the incidence of menstrual disorders in women.

关键词

女性 / 无功能垂体瘤 / 神经内镜 / 经鼻切除 / 月经紊乱 / 危险因素

Key words

female / non-functional pituitary tumor / neuroendoscopy / transnasal resection / menstrual disorders / risk factor

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基金资助

国家自然科学基金资助项目(82173285)