内镜经鼻蝶术后垂体腺瘤患者腺垂体功能低下情况分析  

Analysis of the Postoperative Hypopituitarism in Pituitary Adenomas after Endoscopic TransSphenoidal Microsurgery

作　　者：倪世慧[1] 毕长龙[2] 杨亦春[1] 赵立伟[1] 贾玉锋[1] 王继庆[1] 孙飞[1] 

机构地区：[1]大连大学附属新华医院神经外科,辽宁大连116000 [2]中南大学湘雅医院神经外科,湖南长沙410008

出　　处：《医学临床研究》2016年第2期226-228,共3页Journal of Clinical Research

基　　金：湖南省自然科学基金项目（2011JJ5082）

摘　　要：【目的】检测垂体腺瘤患者内镜经鼻蝶术后相关激素水平变化，分析影响垂体功能低下的因素，指导其激素替代治疗。【方法】总结本院神经外科2008年至2013年内镜下经鼻蝶手术82例垂体腺瘤患者的临床资料及治疗方法，测定患者术前及术后d3甲状腺轴、肾上腺轴及性腺轴相关激素水平并进行比较。【结果】患者术后d3甲状腺轴及肾上腺轴激素水平较术前有所降低，发生腺垂体功能低下者共34例，占41.5%（34/82）。高龄、术前存在垂体功能低下、无功能型、大型肿瘤患者术后发生垂体功能低下比例较高，其中微腺瘤发生率为16.7%（2/12），大腺瘤45.7% （32/70），45例无功能腺瘤发生腺垂体功能减低者16例，占35.5%。而术后腺垂体功能低下发生与患者性别无关。【结论】垂体腺瘤术后垂体相关各项激素水平较术前会有不同程度的下降；术前高龄、垂体功能低下、无功能性垂体腺瘤及肿瘤体积较大的患者，术后发生腺垂体功能低下可能性较高，合理的激素替代疗法有利于患者康复。【Objective】 To investigate the change in the hormonal level of the pituitary adenomas resected by the endoscopic transsphenoidal microsurgery, to evaluate the postoperative damaging factors of pituitary function, and to guide hormonal replacement therapy. 【Methods】We retrospectively analyzed the clinical data and therapeutic methods of 82 cases of obtained pituitary adenomas. The determinations of the hormonal level preoperative and 3d postoperative were detected. These results suggested hypopituitarism and were statistically analyzed. 【Results】The pituitary hormone levels, including thyroid hormone, corticosteroid, and prolactin, were lower 3 days postoperatively in all patients （P〈0.05）. Hypopituitarism was found in 34 cases and accounted for 41.4% of the total 82 patients, including 2 cases of microadenomas （12 cases, 2.4%）, 22 cases of macroadenomas and giant adenomas （70 cases, 16.7%）, and 16 cases of nonfunctional adenomas （45 cases, 35.5%）. Results showed that decreased function or hypopituitarism before operation was more commonly found in elder patients.【Conclusion】The surgical operation could effectively reduce the hormonal level for pituitary adenomas. The ratio of hypopituitarism postoperatively is wellrelated to tumor volume. Hypopituitarism postoperation is more likely to occur in elder patients or cases which had hypopituitarism before operation or nonfunctional adenomas. Reasonable hormone replacement therapy for patient＇s recovery is necessary.

关 键 词：内窥镜检查 垂体肿瘤/外科学 鼻/外科学 蝶窦/外科学 腺瘤/外科学 

分 类 号：R736.4[医药卫生—肿瘤]