经鼻-蝶显微切除垂体腺瘤的疗效及对不同内分泌激素水平的监测意义
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摘要
目的探讨经单鼻孔-蝶窦入路显微手术切除垂体腺瘤的临床疗效。方法回顾性分析广州医科大学附属第六医院神经外科2010年1月—2017年6月,行经单鼻-蝶窦入路显微镜下手术切除垂体腺瘤的145例患者的临床资料。比较分析其手术切除范围、术后临床疗效及手术前后血清催乳素(prolactin,PRL)、生长激素(growth hormone,GH)水平。结果本组患者术后半年时,头痛、视野缺损、视力减退、神经内分泌紊乱(泌乳闭经、性功能障碍、肢端肥大、激素水平异常、向心性肥胖等)等症状明显改善。肿瘤全切组患者术后第1 d、第7 d、第14 d的血清PRL、GH激素水平较术前均明显下降,而未全切组患者无明显变化。手术全切组患者术后第1 d、第7 d、第14 d的血清PRL、GH激素水平比术前明显降低,差异有统计学意义(均P <0. 005)。结论经单鼻孔-蝶窦显微手术切除垂体腺瘤,具有创伤小、手术时间短及并发症低等优点;并能明显改善临床症状和血激素水平;具有较高的临床应用价值。
Objectives To explore the surgical effect of pituitary adenoma by unilateral endonasal transsphenoidal approach. Methods The clinical data of 145 patients with pituitary adenoma microsurgery resection by unilateral endonasal transsphenoidal approach in the Sixth Affiliated Hospital of Guangzhou Medical University between January 2010 and June 2017 were analyzed retrospectively. Resection rang,clinical effect and the level of serum prolactin( PRL) and growth hormone( GH) before and after surgery were compared. Results All 145 cases were followed by 6 months,clinical symptoms,including headache、visual field defects、visual deterioration、neroendocrine disorders( amenorrhea lactation,sexual dysfunction,acral growth,abnormal hormone levels,centrality obesity,etc) were improved significantly. The level of serum PRL and GH were significantly lower than before operation on postoperative 1 d,7 d,14 d,but no obvious change in uncomplete tumor resection group. The level of serum PRL and GH on postoperative 1 d,7 d,14 d were obviously lower compared with two groups,the difference was statiscally significant( P < 0. 005). Conclusion Pituitary Adenoma Resection by Unilateral Endonasal Transsphenoidal Approach has certain advantages of small trauma,little invasion,and low complicationsl et. besides can obviously improve clinical symptoms and the hormone levels of PRL or GH,therefore it is of high value in clinical application.
Objectives To explore the surgical effect of pituitary adenoma by unilateral endonasal transsphenoidal approach. Methods The clinical data of 145 patients with pituitary adenoma microsurgery resection by unilateral endonasal transsphenoidal approach in the Sixth Affiliated Hospital of Guangzhou Medical University between January 2010 and June 2017 were analyzed retrospectively. Resection rang,clinical effect and the level of serum prolactin( PRL) and growth hormone( GH) before and after surgery were compared. Results All 145 cases were followed by 6 months,clinical symptoms,including headache、visual field defects、visual deterioration、neroendocrine disorders( amenorrhea lactation,sexual dysfunction,acral growth,abnormal hormone levels,centrality obesity,etc) were improved significantly. The level of serum PRL and GH were significantly lower than before operation on postoperative 1 d,7 d,14 d,but no obvious change in uncomplete tumor resection group. The level of serum PRL and GH on postoperative 1 d,7 d,14 d were obviously lower compared with two groups,the difference was statiscally significant( P < 0. 005). Conclusion Pituitary Adenoma Resection by Unilateral Endonasal Transsphenoidal Approach has certain advantages of small trauma,little invasion,and low complicationsl et. besides can obviously improve clinical symptoms and the hormone levels of PRL or GH,therefore it is of high value in clinical application.
引文
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[13]张帅,张建鹤,王守森.经鼻蝶入路垂体腺瘤切除术后的MRI改变[J].中华神经医学杂志,2017,16:970.
[14]Patel KS,Kazam J,Tsiouris AJ,et al. Utility of early post-operative high resolution volnmetric MR imaging after transsphenoidal pituitary tumor surgery[J]. World Neurosurg. 2014,82:777.
[15]Pomeraniec IJ,Kano H,Xu Z,et al. Early versus late Gamma knife radiosurgery following transsphenoidal surgery for nonfunctioning pituitary macroadenomas:a multicenter matched-cohort study[J]. J Neurosurg,2017,129:1.
[16]Nishioka H. Recent evolution of endoscopic endonasal surgery for treatment of pituitary adenomas[J]. Neurologia Medico-Chirurgica,2017,57:151.
[17]李祥,于如同,谷佳,等.单鼻孔经蝶窦入路切除垂体腺瘤10年的手术体会[J].临床神经外科杂志,2014,11:423.
[18]周良辅.神经外科学[M].第5版.北京:人民卫生出版社,2015:234.
[19]Mukai K,Kitamura T,Tamada D,et al. Relationship of each anterior pituitary hormone deficiency to the size of non-functioning pituitary adenoma in the hospitalized patients[J]. Endocr J,2016,63:965.
[20]李彪,魏梁锋,丁陈禹,等.垂体腺瘤术后垂体激素水平变化趋势探讨[J].中华神经外科疾病研究杂志,2017,16:239.
[2]陈立华.实用颅底显微外科[M].北京:中国科学技术出版社,2010:528.
[3]刘赫,旷劲松,曹翠平,等. 220例无功能垂体腺瘤临床、病理分析及命名探索[J].中华内分泌代谢杂志,2013,29:155.
[4]Cho HJ,Kim H,Kwak YJ,et al. Clinicopathologic analysis of pituitary adenoma:a single institute experience[J]. J Korean Med Sci,2014,29:405.
[5]Guo-Dong H,Tao J,Ji-Hu Y,et al. Endoscopic versus microscopic transsphenoidal surgery for pituitary tumors[J]. J Craniofac Surg,2016,27:e648.
[6]骆慧,曹胜武,周明卫,等.垂体腺瘤的手术治疗:单中心508例临床总结[J].中国肿瘤外科杂志,2013,5:3.
[7]Zervas NT. Surgical result for pituitary adenomas:result or an international study[M]. New York:Ravenue Press,2014:377.
[8]李昊昱,袁贤瑞,廖艺玮,等.显微经蝶窦入路切除垂体腺瘤术中垂体功能保护技术探讨[J].中南大学学报:医学版,2014,39:136.
[9]Elhadi AM,Hardesty DA,Zaidi HA,et al. Evaluation of surgical freedom for microscopic and endoscopic transsphenoidal approaches to the sella[J]. Neurosurgery,2015,11:69.
[10]靳洪波,徐海峰,马法,等.单鼻孔经蝶入路垂体腺瘤切除术中蝶窦前壁的解剖学研究[J].临床神经外科杂志,2014,11:9.
[11]Dallapiazza RF,Grober Y,Starke RM,et al. Long-term Results of Endonasal Endoscopic Transsphenoidal Resection of Nonfunctioning Pituitary Macroadenomas[J]. Neurosurgery,2015,76:42.
[12]邓光策,李国峰,王岳华,等.单鼻孔经蝶窦入路显微手术治疗垂体腺瘤83例临床分析[J].中南医学科学杂志,2014,42:268.
[13]张帅,张建鹤,王守森.经鼻蝶入路垂体腺瘤切除术后的MRI改变[J].中华神经医学杂志,2017,16:970.
[14]Patel KS,Kazam J,Tsiouris AJ,et al. Utility of early post-operative high resolution volnmetric MR imaging after transsphenoidal pituitary tumor surgery[J]. World Neurosurg. 2014,82:777.
[15]Pomeraniec IJ,Kano H,Xu Z,et al. Early versus late Gamma knife radiosurgery following transsphenoidal surgery for nonfunctioning pituitary macroadenomas:a multicenter matched-cohort study[J]. J Neurosurg,2017,129:1.
[16]Nishioka H. Recent evolution of endoscopic endonasal surgery for treatment of pituitary adenomas[J]. Neurologia Medico-Chirurgica,2017,57:151.
[17]李祥,于如同,谷佳,等.单鼻孔经蝶窦入路切除垂体腺瘤10年的手术体会[J].临床神经外科杂志,2014,11:423.
[18]周良辅.神经外科学[M].第5版.北京:人民卫生出版社,2015:234.
[19]Mukai K,Kitamura T,Tamada D,et al. Relationship of each anterior pituitary hormone deficiency to the size of non-functioning pituitary adenoma in the hospitalized patients[J]. Endocr J,2016,63:965.
[20]李彪,魏梁锋,丁陈禹,等.垂体腺瘤术后垂体激素水平变化趋势探讨[J].中华神经外科疾病研究杂志,2017,16:239.