老年垂体腺瘤的诊治

摘要

目的 探讨老年垂体腺瘤的临床和诊治特点.方法 回顾性分析110例老年垂体腺瘤病人的临床资料.101例行手术切除治疗,9例未行手术治疗.结果 全切除91例,次全切除或部分切除9例,1例为肿瘤凝固性坏死.病理结果均证实为垂体腺瘤.随访78例,时间12～47个月.术前症状均明显好转.术后4个月出现垂体脓肿1例,手术治疗后好转.术后无功能垂体腺瘤进行MRI检查,功能性垂体腺瘤进行激素复查.51例手术病人中,复发3例;5例未行手术病人中,2例行替莫唑胺治疗肿瘤缩小,3例无变化;余22例术后症状改善,未定期行MRI及激素复查.随访期间病人无死亡.结论 老年垂体腺瘤起病隐匿,出现视功能障碍时应尽早行垂体MRI检查.在严格评估手术风险后,经鼻蝶入路垂体腺瘤切除是可行的治疗方法.%Objective To explore the clinical,diagnosis and treatment characteristics of pituitary adenomas in elderly patients.Methods Clinical data of 110 elderly patients with pituitary adenomas were analyzed retrospectively.The tumor resection by surgery was performed on 101 patients and no surgery on 9.Results The tumors were totally resected in 91 patients,subtotally or partially resected in 9 and coagulative necrosis was seen in 1 patient.The pathological diagnosis was conducted as pituitary adenoma.Seventy-eight patients were followed up for 12 to 47 months and the symptoms were improved.The pituitary absess ocurred in 1 patient 4 months after surgery and improved by surgical treatment.The non-functioning pituitary adenomas and functioning pituitary adenomas were analyzed by MRI and hormone reexamination respectively.Relapse occurred in 3 of 51 patients undergoing surgery.Among the 5 patients who did not receive surgery,the tumor shrinked in 2 patients who received temozolomide and remained unchanged in 3.The postoperative symptoms were improved in the left 22 patients who did not periodically receive MRI and hormone reexamination.There was no death during the follow-up period.Conclusions The onset of pituitary adenoma is insidious in elderly patients.The pituitary MRI should be performed for early diagnosis when visual dysfunction symptoms appear.The tumor resection via transsphenoidal approach is credible in elderly patients after critical assessment of surgical risks.