经鼻蝶入路手术治疗垂体腺瘤致肢端肥大症患者的疗效及早期生化指标缓解因素分析  

Effect of transnasal transsphenoidal surgery on acromegaly caused by pituitary adenoma and its early biochemical index remission factors

作　　者：黄银兴[1] 张芳芳 张建鹤[1] 王守森[1] Huang Yinxing;Zhang Fangfang;Zhang Jianhe;Wang Shousen(Department of Neurosurgery, The 900th Hospital of Joint Logistics Team, Fuzong Clinical Medical School of Fujian Medical University, Fuzhou 350025, China;Department of Endocrinology, Fuzhou First Hospital Affiliated to Fujian Medical Unversity, Fuzhou 350009, China)

机构地区：[1]联勤保障部队第九00医院(原南京军区福州总医院),福建医科大学福总临床医学院神经外科,福州350025 [2]福建医科大学附属福州市第一医院内分泌科,350009

出　　处：《中华神经医学杂志》2019年第3期256-262,共7页Chinese Journal of Neuromedicine

基　　金：福建省科技计划引导性项目(2018Y0067);福州市卫生计生中青年科学研究项目(2018-S-wq1);福建医科大学启航基金一般项目(2017XQ1193);福州总医院创新团队项目(2014CXTD-07).

摘　　要：目的探讨垂体腺瘤引起的肢端肥大症患者经鼻蝶入路手术的临床疗效及早期生化指标缓解患者的临床特点。方法南京军区福州总医院神经外科自2014年9月至2017年6月采用显微镜下经鼻蝶入路垂体腺瘤切除术治疗33例肢端肥大症患者,本研究回顾性分析患者的临床资料和疗效。根据术后3个月时患者口服葡萄糖耐量试验(OGTT)后血清生长激素(GH)谷值与胰岛素样生长因子-1(IGF-1)水平,将患者分为生化指标缓解组和生化指标未缓解组,比较2组患者的临床资料与内分泌学检测结果。结果33例患者均成功施行经鼻蝶垂体腺瘤切除术,其中全切除24例,次全切除2例,大部分切除5例,部分切除2例。术后3个月时,9例患者的高血压较前改善,由Ⅱ级降为Ⅰ级或恢复正常;3例患者的心肌肥厚较术前程度减轻;4例患者的心脏扩大较术前改善;1例患者的窦性心律不齐恢复正常;心脏彩超检查显示患者的室间隔厚度较术前降低[(8.36±1.56)mmvs.(9.22±1.24)mm],差异有统计学意义(P<0.05);与生化指标未缓解组(n=14)比较,生化指标缓解组(n=19)患者的腺瘤直径、体积较小,肿瘤包绕颈内动脉角度<135°、Knosp分级0~2级者所占比例较高,肿瘤全切除率较高,术后1周、3个月时IGF-1水平较低,术后1d、2d、3d、1周和3个月时GH水平较低,术前及术后1周、3个月时OGTT后GH谷值较低,差异均有统计学意义(P<0.05)。结论经鼻蝶入路垂体腺瘤切除术是肢端肥大症患者的有效治疗手段,有助于改善患者的心血管并发症。大部分患者能够在术后3个月时达到早期生化指标缓解。早期生化指标缓解患者具有腺瘤较小、OGTT后GH谷值较低、术后IGF-1和GH水平较低等特点。Objective To study the clinical efficacy of transnasal transsphenoidal surgery in acromegaly caused by pituitary adenoma and the clinical characteristics of patients achieved early biochemical remission after surgery. Methods Thirty-three patients with acromegaly caused by pituitary adenoma, admitted to and underwent transnasal transsphenoidal surgery in our hospital from September 2014 to June 2017, were chosen in our study. Clinical data and treatment efficacy of these patients were analyzed retrospectively. The patients were divided into biochemical remission group and non-biochemical remission group according to serum growth hormone (GH) trough value and insulin-like growth factor-1 (IGF-1) levels after oral glucose tolerance test (OGTT) 3 months after surgery, and endocrinology test results of the two groups were compared. Results Thirty-three acromegaly patients underwent microscopic transnasal pituitary surgery. For these patients, 24 achieved total resection, two achieved subtotal resection, 5 achieved massive resection, and two achieved partial resection. Patients were followed up for an average of 13.2 (3-36) months. At 3 months after surgery, blood sugar of two patients with diabetes were restored to normal level;reduction or restoration of hypertension was observed in most patients with preoperative hypertension (81.8%, 9/11);improvement of cardiac hypertrophy or cardiac enlargement was observed in about 1/3 patients with preoperative cardiac organic changes;heart enlargement was improved in 4 patients;one patient had normal sinus arrhythmia. The average interventricular septum thickness of the patients after surgery was significantly reduced as compared with that before surgery ([8.36±1.56] mm vs.[9.22±1.24] mm, P<0.05). The early biochemical remission was achieved in 19 patients (57.6%);as compared with the 14 patients failed to achieve early biochemical remission, those patients achieved early biochemical remission had significantly smaller adenoma diameters and volumes, lower percentages of pati

关 键 词：肢端肥大症 垂体腺瘤 外科手术 生长激素 胰岛素样生长因子-1 

分 类 号：R736.4[医药卫生—肿瘤] R584.11[医药卫生—临床医学]