目的 评价X线立体定向放射外科治疗术后残留垂体腺瘤在控制肿瘤生长和改善内分泌方面的长期疗效.方法 回顾性分析1998年3月至2008年3月X刀治疗的有完整随访结果共206例术后残留垂体腺瘤资料.病灶直径5~35 mm,平均为16.4 mm.治疗时无功能性垂体腺瘤平均中心剂量为22 Gy(20~25 Gy),周边剂量为10 Gy(8～12 Gy);功能性腺瘤平均中心剂量为28Gy(25~30 Gy),周边剂量为12 Gy(10~14 Gy),覆盖病灶体积80%以上.结果 随访24个月以上,肿瘤缩小(含消失)129例(62.6%),无变化74例(35.9%),增大3例(0.15%);在功能性腺瘤中,内分泌恢复正常72例(56.5%),下降53例(42.0%),升高2例(1.5%).所随访的患者无死亡,无严重并发症,无垂体功能低下,35例视力障碍的患者中有13例视力明显好转.结论 X刀治疗术后残留垂体腺瘤临床疗效肯定,是治疗术后残留垂体腺瘤的重要手段.%Objective To evaluate the long tram effect of X - knife stereotactic radio surgery on the tumor growth control and improvement of incretion of the residual pituitary adenomas after operation. Methods From March 1998 to March 2008, 206 patients were treated with X - knife stereotactic radio surgery for residual pituitary adenomas. The lesion diameters ranged from 5mm to 35 mm with a mean diameter of 16.4 mm. For the nonfunctional adenoma, the mean center dose was 22 Gy (20-25 Gy ), and marginal dose 10 Gy (8～12 Gy); for the functional adenoma, the mean center dose was 28 Gy(25～30 Gy), and marginal dose 12 Gy( 10～14 Gy); over 80% lesion volume was covered. Results All patients had been followed - up for over 24 months. The tumor size decreased or completely disappeared in 129 eases ( 62. 6% ), no change was found in 74 cases ( 35. 9% ), evidence of progression was shown in 3 cases ( 0.15% ). For the functional adenoma ones, the incretion was renewed in 72 cases ( 56. 5% ), decreased in 53 cases ( 42.0% ), and increased only in 2 cases ( 1.5% ). There was no death, no serious complication and no hypopituitarism; moreover, 13 of the total 35 patients with visual disorder got obvious improvement of sight. Conclusion X - knife stereotactic radiosurgery is an effective method in the treatment of residual pituitary adenomas.
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