生长激素型垂体瘤合并心肌病外科手术治疗探讨  

Surgical treatment of growth hormone pituitary tumors complicated with cardiomyopathy

作　　者：周和平[1] 陈新生[1] 施正生[1] 查正江[1] 王俊[1] 

机构地区：[1]安徽医科大学附属安庆医院神经外科,安庆246003

出　　处：《中华神经医学杂志》2016年第5期478-482,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨生长激素型垂体瘤合并心肌病患者外科手术治疗及临床疗效。方法选取安徽医科大学附属安庆医院自2007年2月至2015年5月经手术治疗的生长激素型垂体瘤合并心肌病患者15例，采取经鼻-蝶窦手术入路切除垂体瘤，在手术前后行内分泌学、颅脑磁共振成像、超声心动图等相关检查，包括血清生长激素水平、左室舒张末期内径（LVIDd）、室间隔厚度（IVST）、左室后壁厚度（LVPWT）、左室射血分数（EF）、二尖瓣血流频谱（E/A比值）等，并进行对比分析。结果肿瘤全切除9例，次全切除4例，大部分切除2例。垂体瘤切除术后生长激素、LVIDd、IVST、LVPWT、E/A比值、EF均值较术前显著改善，差异均有统计学意义（P〈0.05）。远期随访治愈率为35.68%，缓解率为76.36%。结论积极手术切除垂体瘤，良好控制生长激素水平，能显著改善心脏结构和功能，使生长激素型垂体瘤合并心肌病获得满意治疗效果。Objective To investigate the surgical treatment of growth hormone （GH） pituitary tumors combined with cardiomyopathy patients and its clinical effect. Methods A total of 15 patients with GH pituitary tumors combined with cardiomyopathy were enrolled and underwent surgical treatment from February 2007 to May 2015 in our hospital. Pituitary endocrinology, brain magnetic resonance imaging, echocardiography diagram were inspected before and after surgery. Serum GH level, left ventricular diastolic diameter （LVIDd）, thickness of the interventricular septum （IVST）, left ventricular posterior wall thickness （LVPWT）, left ventricular ejection fraction （EF）, and mitral valve flow spectrum ratio （E/A） were detected by noninvasive methods and compared before and after treatment. Results Through the pituitary adenomas via nasal-sphenoid sinus surgery, total removal of the tumors were noted in 9 patients, subtotal resection in 4 patients, and partial resection in two patients. GH level, LVIDd, IVST, GH, LVPWT, E/A and EF after resection of pituitary tumor were significantly improved as compared with those before resection （P〈0.05）. In the long-term follow-up, the cure rate was 35.68%, and the remission rate was 76.36%. Conclusion Surgical resection of pituitary tumor with good control of growth hormone levels can significantly improve the cardiac structure and function, thereby, GH pituitary tumor patients with cardiomyopathy can obtain satisfactory therapeutic effect.

关 键 词：垂体腺瘤 生长激素 心肌病 

分 类 号：R736.4[医药卫生—肿瘤] R654.2[医药卫生—临床医学]