垂体腺瘤手术治疗中对垂体功能保护的研究
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摘要
目的研究垂体腺瘤手术治疗对垂体功能改善情况,寻找术后发生垂体功能低下的影响因素;为临床预后判断及改善手术疗效提供依据。方法回顾性分析华西医院神经外科2016年1月—2017年1月,行手术治疗的138例垂体腺瘤患者的临床资料;进行垂体功能改善相关因素的分析。结果本组患者中,女性68例,男性70例,平均年龄50岁;术后平均随访17. 6个月。术前垂体功能低下者43例(31. 2%),其中全垂体功能低下者2例(1. 4%),部分垂体功能低下者41例。41例部分垂体功能低下患者中,甲状腺轴受损者13例(30. 2%),术后恢复5例(38. 5%);性腺轴受损15例(34. 9%),术后恢复5例(33. 3%);肾上腺轴受损7例(16. 3%),术后恢复1例(14. 3%);生长激素轴受损6例(14. 0%),术后恢复3例(50%)。术后新发垂体功能低下者6例(4. 3%),其中甲状腺轴受损者2例(33. 3%),性腺轴受损1例(16. 7%)和肾上腺轴受损3例(50%)。无新发全垂体功能低下患者。男性患者术后垂体功能低下的发生率高于女性(67%vs 43%,P=0. 008);老年患者术后更易发生垂体功能低下(61. 7岁vs 47. 9岁,P=0. 017)。结论手术治疗垂体腺瘤能够改善垂体功能低下的预后,尤其是老年及长期罹患垂体功能低下患者。
Objective To investigate the improvement of pituitary functions after operation,searching for risk factors of postsurgical hypopituitarism. Methods The clinical data of 138 patients with pituitary adenoma admitted to West China Hospital,Sichuan University from January 2016 to January 2017 were analyzed retrospectively. Results Of 138 patients,there were 70 males and 68 females with mean age of 50. Preoperative hypopituitarism were detected in 43 patients. Among them there were thyroid axis deficits (n = 13,30. 2%,5 recovered after surgery),male or female reproductive axis deficits (n = 15,34. 9%,5 recovered after surgery),adrenocorticotropic hormone (ACTH)/cortisol axis deficits (n = 7,16. 3%,1 recovered after surgery),growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis deficits (n = 6,14. 0%,3 recovered after surgery) and total hypopituitarism (n = 2,none recovered after surgery). Postoperative newly endocrine deficit rates were 33. 3% for thyroid axis (n = 2),16. 7% for male reproductive axis (n = 1),50% for adrenocorticotropic hormone (ACTH)/cortisol axis (n = 3) and zero for total hypopituitarism. Male patients were prone to have hypopituitarism (67% vs 43%,P = 0. 008). Elder patients were prone to have hypopituitarism postoperative (mean age 61. 7 vs 47. 9 years,P = 0. 017). Conclusion The prognosis of hypopituitarism can be improved through operative resection of pituitary adenoma,especially in older patients or long-time suffering patients.
Objective To investigate the improvement of pituitary functions after operation,searching for risk factors of postsurgical hypopituitarism. Methods The clinical data of 138 patients with pituitary adenoma admitted to West China Hospital,Sichuan University from January 2016 to January 2017 were analyzed retrospectively. Results Of 138 patients,there were 70 males and 68 females with mean age of 50. Preoperative hypopituitarism were detected in 43 patients. Among them there were thyroid axis deficits (n = 13,30. 2%,5 recovered after surgery),male or female reproductive axis deficits (n = 15,34. 9%,5 recovered after surgery),adrenocorticotropic hormone (ACTH)/cortisol axis deficits (n = 7,16. 3%,1 recovered after surgery),growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis deficits (n = 6,14. 0%,3 recovered after surgery) and total hypopituitarism (n = 2,none recovered after surgery). Postoperative newly endocrine deficit rates were 33. 3% for thyroid axis (n = 2),16. 7% for male reproductive axis (n = 1),50% for adrenocorticotropic hormone (ACTH)/cortisol axis (n = 3) and zero for total hypopituitarism. Male patients were prone to have hypopituitarism (67% vs 43%,P = 0. 008). Elder patients were prone to have hypopituitarism postoperative (mean age 61. 7 vs 47. 9 years,P = 0. 017). Conclusion The prognosis of hypopituitarism can be improved through operative resection of pituitary adenoma,especially in older patients or long-time suffering patients.
引文
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[16]王勇,吴冲,张洪亮,等.神经内镜下切除功能性垂体瘤术后激素水平改善的效果分析[J].临床神经外科杂志,2015,12:265.
[17]李振兴,王春晖,王君玉,等.伴脑积水巨大无功能垂体腺瘤的手术治疗(附13例报告)[J].山东医药,2017,57:46.
[18]Raverot G,Burman P,Mc Cormack A,et al.European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas[J].Eur J Endocrinol,2018,178:G1.
[19]纪涛,李维平,黄国栋,等.垂体瘤质地与手术预后的相关性研究[J].中国实用神经疾病杂志,2014,17:17.
[20]刘腾飞,谢涛,张晓彪,等.假包膜外分离技术在神经内镜经鼻蝶垂体腺瘤切除术中的应用[J].中华神经外科杂志,2017,33:979.
[21]屈浙,田军,胡昱红,等.神经内镜下经蝶手术治疗巨大侵袭性垂体腺瘤的临床效果[J].中国医药导报,2018,15:49.
[2]Qiao ND.Outcome of endoscopic vs microsurgical transsphenoidal resection for Cushing’s disease[J].Endocr Connect,2018,7:R26.
[3]Andela CD,Lobatto DJ,Pereira AM,et al.How non-functioning pituitary adenomas can affect health-related quality of Life:a conceptual model and literature review[J].Pituitary,2018,21:208.
[4]Shen CC,Yc W,Hua WS,et al.Endoscopic endonasal transsphenoidal surgery for pituitary tumors[J].Zhonghua Yi Xue Za Zhi(Taipei),2000,63:301.
[5]Kim SY.Diagnosis and treatment of hypopituitarism[J].Endocrinol Metab(Seoul),2015,30:443.
[6]付晓红,薛鑫诚,周培志,等.垂体瘤术后垂体功能变化及激素替代[J].四川大学学报:医学版,2013,44:448.
[7]Lamberts SW.Hypopituitary control and complications study(Hypo CCS):a decade of an outcomes assessment observational study[J].J Endocrinol Invest,2008,31:2.
[8]Fatemi N,Dusick JR,Mattozo C,et al.Pituitary hormonal loss and recovery after transsphenoidal adenoma removal[J].Neurosurgery,2008,63:709.
[9]Jahangiri A,Wagner JR,Han SW,et al.Improved versus worsened endocrine function after transsphenoidal surgery for nonfunctional pituitary adenomas:rate,time course,and radiological analysis[J].J Neurosurg,2016,124:589.
[10]Yamada S,Fukuhara N,Horiguchi K,et al.Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas:a single-center study of 90 cases[J].JNeurosurg,2014,121:1462.
[11]Liao DY,Liu ZY,Zhang J,et al.Staged transcranial and transsphenoidal surgery for giant pituitary adenomas:a retrospective study of 21 cases[J].Zhonghua Yi Xue Za Zhi,2018;98:1306.
[12]Akbari H,Malek M,Ghorbani M,et al.Clinical outcomes of endoscopic versus microscopic trans-sphenoidal surgery for large pituitary adenoma[J].Br J Neurosurg,2018,32:206.
[13]Yu SY,Du Q,Yao SY,et al.Outcomes of endoscopic and microscopic transsphenoidal surgery on non-functioning pituitary adenomas:a systematic review and meta-analysis[J].J Cell Mol Med,2018,22:2023.
[14]Mortini P,Barzaghi LR,Albano L,et al.Microsurgical therapy of pituitary adenomas[J].Endocrine 2018,59:72.
[15]裴傲,崔壮,王作伟,等.内镜经鼻蝶窦入路手术治疗急性卒中垂体腺瘤(附15例报告)[J].中华神经外科杂志,2012,28:229.
[16]王勇,吴冲,张洪亮,等.神经内镜下切除功能性垂体瘤术后激素水平改善的效果分析[J].临床神经外科杂志,2015,12:265.
[17]李振兴,王春晖,王君玉,等.伴脑积水巨大无功能垂体腺瘤的手术治疗(附13例报告)[J].山东医药,2017,57:46.
[18]Raverot G,Burman P,Mc Cormack A,et al.European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas[J].Eur J Endocrinol,2018,178:G1.
[19]纪涛,李维平,黄国栋,等.垂体瘤质地与手术预后的相关性研究[J].中国实用神经疾病杂志,2014,17:17.
[20]刘腾飞,谢涛,张晓彪,等.假包膜外分离技术在神经内镜经鼻蝶垂体腺瘤切除术中的应用[J].中华神经外科杂志,2017,33:979.
[21]屈浙,田军,胡昱红,等.神经内镜下经蝶手术治疗巨大侵袭性垂体腺瘤的临床效果[J].中国医药导报,2018,15:49.
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