高龄非分泌性垂体腺瘤的经蝶手术治疗  

Trans-sphenoidal microsurgical therapy of clinically nonsecreting pituitary adenomas in elderly patients

作　　者：骆纯[1] 卢亦成[1] 胡国汉[1] 楼美清[1] 丁学华[1] 陈菊祥[1] 姚志强[1] 

机构地区：[1]上海市神经外科研究所

出　　处：《中华神经医学杂志》2004年第6期437-439,444,共4页Chinese Journal of Neuromedicine

摘　　要：目的评价高龄非分泌性垂体腺瘤患者经蝶手术的疗效和安全性.方法回顾分析经手术证实的17例年龄在70岁以上垂体腺瘤患者.术前的平均症状期为1.8年,视交叉症状14例.术前内分泌检查提示生长激素(GH)缺乏占70.6%,甲状腺功能低下占35.3%,肾上腺功能低下占47.1%,性腺功能减退和高催乳素血症分别占76.5%和52.9%.肿瘤直径19～52 mm,包括3例局限性和14例侵袭性垂体腺瘤.结果显微镜下肿瘤全切12例,次全切除5例.无围手术期严重并发症,视力视野改进占78.6%.GH均未恢复,甲状腺功能恢复正常占33.3%,血清催乳素(PRL)水平恢复正常占66.7%.免疫组化研究提示促性腺激素细胞腺瘤占52.9%,裸细胞腺瘤占23.5%,大嗜酸粒细胞腺瘤占11.8%,静态促肾上腺皮质激素(ACTH)腺瘤占11.8%.结论在高龄垂体腺瘤中,经蝶手术是一种安全的治疗方法,创伤小,耐受性好,并发症少.Objective To evaluate the efficacy and safety of trans-sphenoidal microsurgical therapy for clinically nonsecreting pituitary adenomas in elderly patients. Methods We retrospectively analyzed surgically treated cases of clinically nonsecreting pituitary adenomas in 17 patients aged more than 70 years. The mean preoperative duration of symptoms was 1.8 years. The chiasmatic syndrome emerged in 14 patients. Preoperative assessments of anterior pituitary function revealed growth hormone deficiencies in 70.6% of the patients, thyroid insufficiencies in 35.3% and adrenal insufficiencies in 47.1%. Hypogonadism and hyperprolactinemia were observed in 76.5% and 52.9% of the patients, respectively. All tumors were macroadenomas, ranging from 19 to 52 mm in size, including 3 enclosed and 14 invasive adenomas. Results Total tumor removal was achieved in 12 cases, and subtotal removal in 5 cases. There were no severe perioperative complications. Visual disturbances were improved in 78.6% of patients. Thyroid function was recovered in 33.3% of patients with preoperative hypothyroidism. In the cases involving hyperprolactinemia, serum prolactin (PRL) levels came to normal in 66.7%. However, growth hormone deficiencies persisted in all patients. Histological and immunohistochemical studies demonstrated gonadotroph adenomas in 52.9%, null-cell adenomas in 23.5%, oncocytomas in 11.8%, and silent adrenocorticotropic hormone (ACTH) adenomas in 11.8%. Conclusion Trans-sphenoidal surgical therapy of pituitary adenomas causing visual disturbances in elderly patients is a safe procedure with advantages of minimal invasiveness, excellent tolerance and fewer complications.

关 键 词：垂体腺瘤 经蝶手术 高龄 分泌性 治疗 正常 术前 细胞 恢复 GH 

分 类 号：R736.4[医药卫生—肿瘤] R735[医药卫生—临床医学]