手术全切除与手术联合伽玛刀治疗160例垂体巨腺瘤的疗效比较  

Efficacy of Total Removal or Subtotal Removal Combined Gamma Knife Radiation on Giant Pituitary Adenoma:A Report of 160 Cases

作　　者：肖其华[1] 黄思庆 毛伯镛[1] 李国平[1] 鞠延[1] 

机构地区：[1]四川大学华西医院神经外科,四川成都610041

出　　处：《癌症》2007年第7期742-747,共6页Chinese Journal of Cancer

摘　　要：背景与目的:垂体腺瘤是常见的颅内良性肿瘤,其治疗方法主要有手术、药物及放射治疗。但预后并不令人满意,对巨腺瘤尤其如此。本研究分析手术全切除治疗及手术联合!-刀对直径大于50mm的垂体巨腺瘤的疗效,探讨治疗垂体巨腺瘤的合理有效的方式。方法:160例患者分两组:A组90例手术全切除肿瘤,B组70例手术大部分切除肿瘤后加用γ-刀放射治疗(即联合治疗组)。分析两组患者的症状改善情况、MRI显示的肿瘤大小改变、激素水平的变化及并发症的发生率及死亡率。结果:12个月后手术全切组患者死亡率3.3%(3/90),有效率74.4%,复发率31.1%;而联合治疗组无患者死亡,其有效率为91.4%,复发率11.4%。24个月及目前随访的两组死亡率、复发率明显升高,而有效率则有所下降,两组比较差异有统计学意义(P<0.05),联合治疗组疗效明显好于手术全切组。进一步比较发现,治疗后12个月内两组激素水平下降情况(主要是监测PRL及CH腺瘤)差异无统计学意义,但12个月后则差异有统计学意义,联合治疗组较手术全切组激素水平下降更明显。在并发症的发生上手术全切组明显较联合治疗组多而重。结论:对垂体巨腺瘤而言,手术大部分切除肿瘤后加用γ-刀治疗的疗效明显优于单纯手术全切除肿瘤。BACKGROUND ＆ OBJECTIVE： Pituitary adenoma, a kind of familiar benign intracranial tumor, is mainly treated with surgical operation, medication, and radiation. However, the outcome, especially for giant pituitary adenoma, is not very satisfactory. This study was to explore the efficacy of total tumor removal or subtotal tumor removal combined gamma knife radiation on giant pituitary adenoma. METHODS： Clinical data of 160 giant pituitary adenoma patients were analyzed. Of the 160 patients, 90 received total tumor removal, 70 received subtotal tumor removal combined gamma knife radiation. The symptom improvement, tumor size change, serum hormone concentration, complications after treatment, and so on, of the 2 groups were compared. RESULTS： At 12 months after treatment, the efficiency rate, recurrence rate, and mortality were 74.4%, 31.1%, and 3.3%, respectively, in total tumor removal group： however, the efficiency rate reached 91.4%, the recurrence rate decreased to 11.4%, and no patients died in combined therapy group. The follow-up results at 24 months after treatment and at present （over 5 years） showed that though the efficiency rate had descended and recurrence rate or mortality had ascended in both groups, the efficacy of combined therapy was obviously better than that of total tumor removal. The decrease of serum hormone concentration was more obvious in combined therapy group than in total tumor removal group at 12 months after treatment. Moreover, total tumor removal group had more serious complications than combined therapy group after treatment. CONCLUSION. Subtotal tumor removal combined gamma knife radiation is better than total tumor removal for giant pituitary adenoma.

关 键 词：垂体腺瘤 显微外科手术 γ刀-治疗 疗效 

分 类 号：R736.4[医药卫生—肿瘤]