垂体生长激素腺瘤经蝶手术的疗效及影响疗效的相关因素

摘要

Objective:To study the curative effect and its influence factors of transsphenoidal microsurgery in the growth hormone-secreting pituitary adenoma.Methods:All 59 patients with growth hormone-secreting pituitary adenoma in our hospital were selected.The transsphenoidal approach in the resection of pituitary adenoma was available.The patient''s recovery,treatment outcome and influence factors were observed.Results:There were 43 cases of adopting the total resection,11 cases of adopting the subtotal resection and 5 cases of adopting the partial excision.After treatment,there were 53 cases of recovery of hormone level.In terms of postoperative complications,there were 16 cases had diabetes insipindus,6 cases leakage of cerebrospinal fluid,3 cases hypopituitarism,8 cases hyponatremia,and 8 cases residual tumor.There was no dead or infection case.After 6 months of follow-up visit,there was no recurrent case.The size of tumor,growth hormone before surgery and tumor invasion had a certain effect in the patient''s treatment outcome(P<0.05).Conclusion:The transsphenoidal approach has a favorable effect in the treatment of growth hormone-secreting pituitary adenoma,especially for microadenoma and non-invasive adenoma.For patients with invasive adenoma or huge adenoma,the chemotherapy shall also be considered in obtaining the better treatment outcome.%目的:探讨垂体生长激素腺瘤经蝶手术的疗效及影响手术疗效的相关因素.方法:临床纳入垂体生长激素腺瘤患者59例,手术方案均采用经单鼻孔蝶窦入路垂体腺瘤切除术.观察所有患者术后恢复情况及治疗效果,同时寻找影响手术效果的相关因素.结果:59例患者中,43例接受了肿瘤全切术,11例接受了肿瘤次全切术,5例接受了肿瘤部分切除术.所有患者术后相关临床症状均较前有了不同程度的改善,59例垂体生长激素腺瘤患者术后有53例激素水平有着不同程度的恢复.术后并发症方面,16例患者发生尿崩,6例患者发生脑脊液漏,3例患者出现垂体功能低下,8例患者出现低钠血症,8例患者术后存在肿瘤残余.围手术期间,未出现1例患者死亡,亦未出现感染病例.术后对患者进行为期6个月的临床随访,未发现复发者.影响手术疗效因素方面,肿瘤大小、术前生长激素水平、肿瘤侵袭性均对患者手术疗效有着一定程度的影响(P<0.05).结论:经单鼻孔蝶窦入路垂体腺瘤切除术治疗垂体生长激素腺瘤有着令人满意的临床疗效,特别是微腺瘤与非侵袭性腺瘤应用该术式能够取得较好的效果,而侵袭性腺瘤或巨大腺瘤患者在术后往往需要配合放化疗,以达到提高疗效的目的.