激素评估垂体生长激素腺瘤经蝶手术疗效  

Evaluation of endocrinological outcome of transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas

作　　者：王海军[1] 毛志钢[1] 朱永红[1] 何东升[1] 徐伟光[1] 冯雷[1] 

机构地区：[1]中山大学附属第一医院神经外科,广州510080

出　　处：《中华神经医学杂志》2006年第1期45-48,共4页Chinese Journal of Neuromedicine

摘　　要：目的按肢端肥大症治疗的指导原则中肢端肥大症治愈的标准,用激素变化并结合影像学复查来评价垂体生长激素腺瘤经蝶手术疗效。方法回顾性分析经蝶手术治疗、资料完整的60例垂体生长激素腺瘤患者的临床资料、经蝶手术后激素变化等;根椐肿瘤大小、术前生长激素水平、侵袭性等进行分类,用术后激素水平结合影像学复查来比较手术疗效。结果按此治愈标准,本组总缓解率为68.3%,其中微腺瘤缓解率87.5%,大腺瘤69.2%,巨大腺瘤46.2%;侵袭性和非侵袭性腺瘤则为36.8%和79.1%。微腺瘤与巨大腺瘤、侵袭性和非侵袭性腺瘤术后缓解率有统计学差异(P<0.05)。结论术后激素水平比影像学复查能更好地评价垂体生长激素腺瘤的疗效,手术疗效与肿瘤大小和是否侵袭性生长有关。对于微腺瘤和非侵袭性大腺瘤,经蝶手术可取得满意疗效;对于侵袭性腺瘤垂体腺瘤或巨大腺瘤,经蝶手术治愈率较低。部分患者术后应加用辅助治疗。Objective To evaluate the therapeutic effect of transsphenoidal microsurgery for growth hormone （GH）-secreting pituitary adenomas through endocrinological and imaging examination and on the basis of strict postoperative GH and insulin like growth factor （IGF-Ⅰ） criteria. Methods The clinical data of sixty patients of GH-secreting adenomas undergoing transsphenoidal microsurgery were analyzed retrospectively and the hormone change after operation was evaluated. Biochemical remission was defined as a postoperative random GH level of less than 2.5μg/L and a repeated fasting or glucose-suppressed GH level of 1μg/L or less, and a normal age- and gender-matched IGF-Ⅰ level. The tumors were classified according to tumor size, invasion, preoperative GH levels, etc. The postoperative outcomes were evaluated on the criteria and imaging examination. Results Biochemical remission was achieved in 68.3% of all patients after one operation, including 87.5% of patients with microadenomas and 69.2% of patients with macroadenomas of 11 to 40 mm in size, as compared with a 46.2% remission rate for patients with adenomas larger than 40 ram. On the other hand, 41.2% of patients with invasive adenomas achieved remission, as compared with a remission rate for patients with noninvasive adenomas 79.1%. The differences of statistical significance were found in remission rates between microadenomas and macroadenomas （P〈0.05）, between invasive adenomas and noninvasive adenomas （P〈0.05）. Conclusion On the basis of strict postoperative GH and IGF-Ⅰ criteria to define remission, our series demonstrates the postoperative GH and IGF-Ⅰ levels to evaluate the therapeutic effect of transsphenoidal microsurgery are better than the imaging examination. The therapeutic outcome is associated with the tumor size and invasiveness. The outcome of transsphenoidal surgery for acromegalic patients with microadenomas and noninvasive adenomas was relatively satisfying, while the patients with invasive adenomas or giant pituitary

关 键 词：垂体肿瘤 生长激素 经蝶手术 胰岛素类生长因子1 

分 类 号：R736.4[医药卫生—肿瘤]