经蝶窦垂体瘤显微切除术治疗Cushing病的疗效分析  

AN ANALYSIS OF THE EFFECT OF TRANSSPHENOIDAL PITUITARY MICROSURGERY FOR CUSHING DISEASE

作　　者：陆召麟[1] 郭爱丽[1] 曹琰[1] 张洁萍[1] 方京辉 窦平[1] 任祖渊[2] 苏长保[2] 臧旭[3] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院内分泌科,100730 [2]中国医学科学院中国协和医科大学北京协和医院神经外科,100730 [3]中国医学科学院中国协和医科大学北京协和医院病理科,100730

出　　处：《中华内分泌代谢杂志》1996年第1期3-5,共3页Chinese Journal of Endocrinology and Metabolism

摘　　要：总结了自1980年初至1992年底经蝶显微外科手术治疗Cushing病103例的手术疗效。其中41例进行了选择性垂体腺瘤切除术,62例行垂体瘤及瘤周垂体前叶组织大部切除术。结果:近期有效率为83.5％,远期痊愈率为60.2％,复发率为11.4％。术后病理发现肿瘤者痊愈率为63.1％,而未见肿瘤者痊愈率为48.1％。垂体瘤及瘤周垂体前叶组织大部切除术的痊愈率72.6％,明显高于选择性肿瘤切除术的41.5％（P<0.001）。痊愈者术后48小时内血浆皮质醇水平即降至正常或低于正常,术后好转和无效者,其水平一般仍明显高于正常。术后有1.6％的病例（1/60例）出现继发性甲减,62.5％（30/48例）术前月经紊乱者在术后恢复正常。垂体瘤及瘤周垂体前叶组织大部切除术的疗效优于选择性肿瘤切除术;术后病理检查发现肿瘤者及术后48小时内血浆皮质醇水平明显下降或低于正常者预后良好。From the beginning of 1980 to the end of 1992, 125 patients with Cushing disease were undergone transsphenoidal microsurgery. 41 patients were operated by selective adenoma resection and 62 patients by radical surgery. 103 cases were available to be analyzed. The results of a long-term follow-up showed: (1) The cure rates were 63. 1% and 48.1% with positive and negative pathological study, respectively. (2) The cure rates were 72.6% and 41. 5% with radical and selective surgery respectively. In cured patients the plasma cortisol level dropped to normal or subnormal within 48 hours after the surgery. However, in uncured patients, it was still above the normal. After operation, 1. 6% of cases (1/60) had secondary hypothyroidism and 62.5 % of cases (30/48) who had abnormal menstruation preoperatively restored normal menstrual cycle. The recurrent rate was 11.4%. Conclusion: (1) The outcome of radical surgery is better than the selective adenoma resection; (2) The pathological study and the analysis of the plasma cortisol level within 48 hours after the surgery may have predictive value for efficacy of the surgery.

关 键 词：CUSHING病 显微手术 经蝶窦 垂体瘤 

分 类 号：R586.205[医药卫生—内分泌] R736.405[医药卫生—内科学]