垂体瘤509例临床特点及术后长期随访分析  

Pituitary tumors:a long-term following-up analysis of 509 cases

作　　者：彭蒙蒙[1] 梁琳琅[1] 邢雪[1] 

机构地区：[1]辽宁医学院沈阳军区总医院研究生培养基地,沈阳110016

出　　处：《中国实用内科杂志》2014年第5期488-491,共4页Chinese Journal of Practical Internal Medicine

基　　金：全军"十一五"面上项目课题(06MA053)

摘　　要：目的探讨垂体瘤临床特点、术后恢复及随访中的问题和解决办法,提升垂体瘤患者生存质量。方法对沈阳军区总医院2008年5月至2013年5月收治的509例垂体瘤术后患者病史、诊疗结局、激素评估、激素替代及随访资料进行分析。结果患者入院主诉以头痛(49.1%)、视野视力改变(55.6%)为主;以垂体大腺瘤为主(96.3%)。病理类型以嫌色细胞瘤为主(93.6%)和无功能瘤最多(49.1%)。术前测定垂体激素者占79.6%,而缺乏靶腺激素测定以皮质醇(83.1%)、性腺激素(74.7%)为主;术后无垂体激素测定者占66.0%,无垂体-甲状腺轴功能评价者占79.0%,无皮质醇、性腺激素测定者分别占97.6%和93.1%。术后垂体-甲状腺轴低功最多(66例,61.7%),住院期间给予激素替代治疗者49例(74.2%)。落实随访113例,其中有73例(64.6%)遵医嘱进行复查,完善内分泌激素评估的14例(12.4%)。结论术前和术后对垂体-靶腺激素评估不够,动态功能试验实施较少;术后落实随访率低;随访低功患者激素替代治疗欠规范、依从性差,生活质量改善不明显。Objective To discuss the clinical characteristics of pituitary tumors, find problems and solutions after surgery and during follow up,and improve the quality of life of these patients. Methods We statistically evaluated clinical data of 509 postoperative patients with pituitary adenoma, including history of hospitalization, treatment process, hormone evaluation, hormone replacement status and followed up data. Results Patients mainly complained with headache （49. 1% ） and alterations of vision and visual field （55.6%）, and mainly found with pituitary macroadenoma （96. 3% ）. Chromophobe cell tumors （93.6%） and non-functional tumors （49. 1% ） were the main pathological type. Patients with pre-operative pituitary hormone measurements accounted for 79. 6% , and those lacked measurements of the target hormone were patients with measurements of cortieosteroid （83.1% ） and sex hormone （74. 7% ）. Patients without post-operative measurements of pituitary hormone accounted for 66.0%. Patients without evaluation of pituitary-thyroid gland axis function accounted for 79.0% , and those without measurements of corticosteroid and sex hormone accounted for 97.6% and 93.1% respectively. There were most patients with low post-operative pituitary-thyroid gland axis function （n = 66,61.7% ）. During hospitalization ,49 patients received hormone replacement therapy （74. 2% ）. Follow up was implemented in 113 cases, of whom 73 cases （64. 6% ） received re-examination,and evaluations were improved in 14 cases （ 12.4% ）. Conclusion Pre- and postoperative measurements of the target pituitary hormone are not enough, so are dynamic functional examinations. Follow up is not implemented well and hormone replacement therapy is not standardized for the followed-up patients with low function. Meanwhile, compliance of patients is had and improvement of life quality is not obvious.

关 键 词：垂体腺瘤术后 激素评价 术后恢复 激素替代 

分 类 号：R736.4[医药卫生—肿瘤]