立体定向放射神经外科机器人CYBER刀系统治疗垂体瘤的效果  

Effect of stereotactic radioneurosurgery robot CYBER knife system in the treatment of pituitary adenoma

作　　者：韦鹏翔 张红波[3] 汪延明 WEI Pengxiang;ZHANG Hongbo;WANG Yanming(Department of Neurosurgery, Shunde Hospital Affiliated to Guangzhou Chinese and Western Medicine University, Guangdong Province, Fuoshan 528333, China;Department of Neurosurgery, Dongfang Hospital Affiliated to Beijing Traditional Medical University, Beijing 100078, China;Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, the National Key Clinic Specialty, the Engineering Technology Research Center of Education Ministry of China, the Neurosurgery Institute of Guangdong Province, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Southern Medical University, Guangdong Province, Guangzhou 510282, China;Department of Neurosurgery, 960 Hospital of PLA, Shandong Province, Ji′nan 250031, China)

机构地区：[1]广州中医药大学顺德医院神经外科,广州佛山528300 [2]北京中医药大学东方医院神经外科,北京100078 [3]南方医科大学珠江医院神经外科,广东广州510282 [4]解放军960医院神经外科,山东济南250031

出　　处：《中国医药导报》2019年第11期62-64,共3页China Medical Herald

基　　金：中国博士后科学基金资助面上项目(2018M640802)

摘　　要：目的探讨立体定向放射神经外科(SRNS)机器人CYBER刀系统治疗垂体瘤的治疗途径,为垂体腺瘤的治疗开辟无创治疗新路。方法选取2015年5月～2018年12月解放军960医院及山东省医学科学院附属医院收治的垂体瘤患者12例,应用美国第五代无创机器人赛博刀(CYBERKNIFE)系统治疗,采用126个放射节点,分3次治疗,每次间隔24 h,三次总剂量20 Gy;肿瘤边缘视神经剂量20 Gy,结合临床症状及内分泌变化,分析CYBERKNIFE治疗垂体腺瘤的效果。结果泌乳素(PRL)肿瘤6例,生长激素(GH)肿瘤6例;肿瘤直径2.0～3.5 cm,平均(2.30±0.78)cm。术前4例PRL显著升高>200 ng/L,平均(390.00±45.32)ng/L,2例增高37.5～68.6 ng/L,平均(46.00±17.69)ng/L,6例GH升高,平均(14.00±9.13)ng/L。治疗2周后复查MRT2显示肿瘤放射性坏死;术后复查4例激素完全恢复正常,神经内分泌紊乱8例,其中6例恢复正常,轻度下降1例,无改善1例;术后随访3～11个月,平均5.8个月,内分泌功能低下1例,口服强的松及甲状腺素替代治疗。复发1例手术治疗。无永久性尿崩及手术死亡病例。结论应用立体定向无框架放射神经外科CYBER刀系统,以20 Gy损毁剂量,100节点以上分次治疗垂体瘤安全可行。Objective To explore the approaches to CYBER knife system for stereotactic radiosurgery (SRNS) in the treatment of pituitary adenoma, and to open up a new non-invasive way for the treatment of pituitary adenoma. Methods A total of 12 patients with pituitary tumor Admitted to 960 Hospital of PLA and Affiliated Hospital of Shandong Acodemy of Medical Sciences from May 2015 to Decmber 2018 were selected and treated with CYBER knife system, a fifth-generation non-invasive robot from the United States. 126 radiating nodes were used, and the treatment was divided into three times, with each interval of 24 h and three times of total dose of 20 Gy. The dose of the optic nerve at the edge of the tumor was 20 Gy, combined with the clinical symptoms and endocrine changes, the efficacy of CYBER knife in the treatment of pituitary adenoma was analyzed. Results There were 6 cases of PRL tumor and 6 cases of GH tumor. The tumor diameter was 2.0 - 3.5 cm, with an average (2.30±0.78) cm. The preoperative PRL in 4 patients was significantly higher than 200 ng/L, with an average (390.00±45.32) ng/L, 2 patients increased, with an range value of 37.5 - 68.6 ng/L, and with an average (46.00±17.69) ng/L, GH of 6 patients elevated, and with an average (14.00±9.13) ng/L. MRT2 reexamination 2 weeks after treatment showed tumor radionecrosis. Postoperative reexamination showed that 4 cases of hormone completely returned to normal, 8 cases of neuroendocrine disorder, of which 6 cases returned to normal, 1 case of mild decrease, and 1 case without improvement. The patients were followed up for 3 to 11 months, with an average of 5.8 months. One patient had low endocrine function and received oral prednisone and thyroxine replacement therapy. One case of recurrence was treated by surgery. No permanent diabetes insipidus or death from surgery. Conclusion It is safe and feasible to apply the CYBER knife system of stereotactic non-frame radioneurosurgery to treat pituitary adenoma at a dose of 20 Gy and above 100 nodes.

关 键 词：垂体瘤 CYBER刀 治疗 

分 类 号：R736.4[医药卫生—肿瘤]