不同生长方式颅咽管瘤患者垂体功能减退模式  

Hypopituitarism mode in patients with craniopharyngioma in relation to tumor growth pattern

作　　者：漆松涛[1] 彭俊祥[1] 潘军[1] 樊俊[1] 张世超[1] 刘忆[1] 包赟[1] 邱炳辉[1] 伍学焱[2] 

机构地区：[1]南方医科大学南方医院神经外科,广州510515 [2]中国医学科学院北京协和医学院北京协和医院内分泌科

出　　处：《中华医学杂志》2018年第1期19-24,共6页National Medical Journal of China

摘　　要：目的研究不同生长方式颅咽管瘤患者围手术期与远期随访垂体激素的变化规律。方法回顾性分析南方医科大学附属南方医院2001年1月至2012年5月间，以手术全切除为目的进行治疗的212例原发颅咽管瘤的临床资料，根据颅咽管瘤QST外科学分型，分析不同生长方式的颅咽管瘤患者手术前、手术后早期及远期垂体激素水平以及相关临床特征。结果177例（83．5％）患者术前出现垂体功能减退，其中36例为全垂体功能减退，术后早期垂体功能可进一步加重，下丘脑-垂体-肾上腺轴、下丘脑-垂体-甲状腺轴减退在术后远期的发生率分别为60．1％、58．3％，多数患者术后需要行肾上腺激素及甲状腺激素的替代治疗，不同生长方式的颅咽管瘤垂体功能减退模式存在差异。结论颅咽管瘤垂体功能减退模式与QST分型相关，这种分型有利于治疗方法的选择及预后判断，是持续改进颅咽管瘤神经内分泌监控、治疗与健康教育的重要依据。Objective To investigate the pituitary hormone changes of patients with craniopharyngioma of different growth patterns during perioperative period and follow up time. Methods Retrospective studies were performed on 212 cases of primary craniopharyngioma patient who received total tumor excision surgery in our hospital from January 2001 to May 2012. The characteristics of pituitary hormone and associated clinical manifestation during preoperative, perioperative and postoperative periods were analyzed according to the QST surgical classification. Results One hundred and seventy-seven （83.5%） of patients present preoperative hypopituitarism, 36 of them were panhypopituitarism. The hypopituitarism condition was exacerbated during the early stage of post-operation period. The abnormal rates of HPA and HPT during the follow up were 60. 1% and 58.3% respectively and hormone replacement treatment was needed for these patients. Craniopharyngioma of different growth patterns showed diversities in the characteristics of hypopituitarism. Conclusion QST surgical classification was closely associated with the pattern of hypopituitarism, it can help to optimize treatment and prognosis estimation, and could be important criterion for improving the clinical practice of neuroendoerine monitoring, treatment and health education of patients with craniopharyngioma.

关 键 词：颅咽管瘤 肿瘤分型 垂体功能减退 

分 类 号：R584.2[医药卫生—内分泌] R739.41[医药卫生—内科学]