肢端肥大症手术前后心脏病变改善的临床研究  

Clinical research of improvement of heart disease after the surgery for acromegaly

作　　者：郭晓鹏[1] 高路[1] 汪强[1] 王子豪[1] 周晴[1] 方理刚[2] 幸兵[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院神经外科,100730 [2]中国医学科学院北京协和医学院北京协和医院心内科,100730

出　　处：《中国微侵袭神经外科杂志》2017年第4期154-157,共4页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探索肢端肥大症病人心脏病变在经蝶手术后早期的改善情况。方法回顾性分析30例肢端肥大症病人的临床资料。术前超声诊断心脏病变17例(56.7%),其中心房心室腔增大11例,舒张功能下降9例,瓣膜改变9例,大动脉根部增宽8例,心肌肥厚2例,收缩功能下降1例。所有病人行经鼻蝶窦入路垂体腺瘤切除术。结果术前病人右心室前后径、室间隔厚度、左心室后壁厚度分别(23.97±3.21)mm、(9.00±1.17)mm、(8.70±1.06)mm;术后随访3个月,病人右心室前后径(21.90±3.51)mm、室间隔厚度(8.12±1.50)mm及左室后壁厚度(7.78±1.24)mm,均较术前明显减小(P<0.05)。而心脏舒缩功能、大血管内径及瓣膜病变指标较术前差异无统计学意义(P>0.05)。23例(76.7%)病人达到内分泌治愈。结论肢端肥大症病人多合并心脏病变,术后早期心房心室腔内径及心肌厚度可部分改善,但心脏功能、大血管内径及瓣膜病变改善不明显。Objective To investigate the improvements of heart disease in the early period after surgery in acromegalic pa Methods Clinical data of 30 patients with acromegaly were analyzed retrospectively. The preoperative echocardiography was used to diagnose 17 patients （56.7%） with heart diseases, including heart cavity enlargement in 11, diastolic dysfunction in 9, valvular disease in 9, expansion of large vessel root in 8, myocardial hypertrophy in 2 and systolic dysfunction in 1. The pituitary adenomas were removed by surgery via transsphenoidal approach in all the patients. Results The anteroposterior diameter of the right ventricle, thickness of interventricular septum and thickness of the posterior wall of the left ventricle were （23.97 _＋ 3.21） mm, （9.00 -＋ 1.17） mm and （8.70 _＋ 1.06） mm respectively before surgery. The postoperative corresponding parameters were （21.90 ＋ 3.51）ram, （8.12 ＋ 1.50） mmand （7.78 ＋ 1.24） mm respectively 3 months after surgery, which were decreased significantly than those before surgery （P 〈 0.05）. However, no changes were found in diastolic and systolic fimction, large vessel diameter and valvular disease indexes （P 〉 0.05）. During follow-up period of 3 months after surgery, 23 patients （76.7%） achieved hormone recovery. Condusions Heart disease is common in acromegalic patients. In the early postoperative period, heart cavity and myocardium thickness can be improved partly, but improvement of cardiac fimction, large vessel diameter and valvular disease are not obvious.

关 键 词：肢端肥大症 心脏病变 入路 经蝶 心肌肥厚 心腔扩大 

分 类 号：R584.11[医药卫生—内分泌] R541[医药卫生—内科学]