经蝶手术治疗垂体生长激素腺瘤合并空蝶鞍综合征疗效分析  

Therapeutic effects of transsphenoidal microsurgery on growth-hormone-secreting pituitary adenomas associated with empty sella syndrome(report of 41 cases)

作　　者：郭晓鹏[1] 赵羽西[1] 高路[1] 姚勇[1] 邓侃[1] 连伟[1] 王任直[1] 幸兵[1] 

机构地区：[1]北京协和医院神经外科,100730

出　　处：《中国临床神经外科杂志》2015年第5期265-267,270,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨垂体生长激素（GH）腺瘤合并空蝶鞍综合征（ESS）的手术方法及其疗效。方法回顾性分析2010年1月至2013年12月经蝶入路手术治疗的41例垂体GH腺瘤合并ESS患者的临床资料。所有患者术后随访1～4年,平均2.3年;空腹或随机血清GH〈2.5 ng/ml,或GH葡萄糖抑制试验示GH谷值〈1 ng/ml为治愈标准。结果术后6个月治愈32例（78.0%）,未愈9例（22.0%）。随访期间32例治愈患者均未复发;9例未愈患者中,1例行放疗,其随机GH未降至正常水平、GH葡萄糖抑制试验GH谷值〉1 ng/ml,其他8例患者未行特殊治疗患者中3例治愈。术后发生并发症13例（31.7%,13/41）,其中一过性电解质紊乱12例（低钾血症8例,低钠血症3例,高钠血症1例）,一过性尿崩症4例,脑膜炎1例,经积极治疗均痊愈出院。结论经蝶手术是垂体GH腺瘤合并ESS患者的有效治疗方法。Objective To discuss the surgical method to treat the growth-hormone-secreting pituitary adenomas （GHSPA） associated with empty sella syndrome （ESS）, microsurgical effects on them and postoperative complications. Methods The clinical data of 41 patients with GHSPA associated with ESS, who were treated by transsphenoidal microsurgery from January, 2010 to December, 2013, were analyzed retrospectively. Of 41 cases of GHSPA, 23 were type A GHSDPA which referred to GHPSA beneath the cavum subarachnoidale, 12 were type B which to GHSPA lateral to the cavum subarachnoidale and 6 were type C which to GHSPA encircled by the cavum subarachnoidale. Results Following-up from 1 to 4 years showed that the cured rates of types A, B, and C GHSPA were 91.3% （21/23）, 83.3% （10/12）, and 66.7% （4/6） respectively according to the postoperative serum levels of growth hormone suppression test and insulin growth factor-1. The overall postoperative complications rate was 31.7% （13/41）. Conclusions The transsphenoidal microsurgery is a good method to treat GHSPA associated with ESS and its curative effect on GHSPA associated with ESS is good.

关 键 词：垂体生长激素腺瘤 肢端肥大症 空蝶鞍综合征 经蝶显微手术 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]