垂体瘤手术前后垂体激素测定及其临床意义
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摘要
目的 垂体瘤是颅内常见的良性肿瘤，约占颅内肿瘤的10％，对垂体腺瘤病人手术前后垂体激素的检测目的是为了对垂体腺瘤进行术前激素分型、术后垂体功能的检验以及寻求一种判断手术切除的程度及术后有无复发的方法。
方法 采用放免法对50例垂体腺瘤手术的病人，根据手术切除程度不同分组，测定术前术后激素水平，对测定值进行回顾性分析，应用配对资料的t检验对每组资料手术前后垂体激素的测定值进行数据分析，应用两样本均数的t检验对两组资料手术后垂体激素的测定值进行数据分析，判断检测结果的相互关系并分析其临床意义。
结果 PRL腺瘤及GH腺瘤手术全切及未全切组手术后激素水平均较术前明显降低(P＜0.05)，表明手术可以纠正内分泌紊乱；对手术全切与未全切组之间的比较，发现术后激素水平的改变有明显差异(P＜0.05)，说明手术的切除程度与垂体激素的降低呈正相关。
结论 手术治疗可以明显改善垂体瘤患者术前高激素水平状态，手术治疗有着肯定的治疗价值。手术的切除程度将决定着术后内分泌的改善水平，要在不损害正常垂体前提下争取全切肿瘤。
OBJECTIY Pituitary adenoma is an common intra-cranial tumor, about 10 percent of intra-cranical tumors.The detecting the change of pituitary hormone after tumor excision aims to make groups of pituitary adenoma before operation and to detect the postopera-tional pituitary as well as to suit an effective method to decide the degrees of tumor removal and reoccour after operation.
METHODS Among 50 patients with pituitary hormone, the analysis of the value of pituitary hormone is reviewed retrospectively, according to the degree of tumor removal . The values of pituitary hormone on each group between preoperation and postoperation are analysed by t-test of paired samples. The values of postoperation pituitary hormone between two groups are analysed by t-test of mean of two samples. The clinical significant of relationship between the degree of tumor removal and the values of pituitary hormone is di scovered.
RESULTS The values of pituitary hormone after operation are decrease significantly after both complete and uncomplete tumor removal in PRL adenomas as well as GH adenomas (P<0. 05) , which shows operations
can correct the disturbance of endocrine. After comparing the values of pituitary hormone between the complete group and the uncomplete group, there is significant difference which shows the degrees of tumor removal affect the values of pituitary hormone after operation (P<0.05).
CONCLUSION The higher level of pituitary hormone can be cut down by operat ion,which demonstrates operation can' t be rep 1 ac ed. "In1 dei;reeof tumor removal plays an role in the change o em ocrine, which shows pituitary adenomas must be completely excised based on not injurying the normal pituitary tissues.
PURPOSE There is correlation between the degree of tumor removal and the correction of endocrine. The detection of endocrine hormone can he used to evalue the effciacy of operation,which plays an important role in clinical treatment of pituitary adenomas ami prognosis.
方法 采用放免法对50例垂体腺瘤手术的病人，根据手术切除程度不同分组，测定术前术后激素水平，对测定值进行回顾性分析，应用配对资料的t检验对每组资料手术前后垂体激素的测定值进行数据分析，应用两样本均数的t检验对两组资料手术后垂体激素的测定值进行数据分析，判断检测结果的相互关系并分析其临床意义。
结果 PRL腺瘤及GH腺瘤手术全切及未全切组手术后激素水平均较术前明显降低(P＜0.05)，表明手术可以纠正内分泌紊乱；对手术全切与未全切组之间的比较，发现术后激素水平的改变有明显差异(P＜0.05)，说明手术的切除程度与垂体激素的降低呈正相关。
结论 手术治疗可以明显改善垂体瘤患者术前高激素水平状态，手术治疗有着肯定的治疗价值。手术的切除程度将决定着术后内分泌的改善水平，要在不损害正常垂体前提下争取全切肿瘤。
OBJECTIY Pituitary adenoma is an common intra-cranial tumor, about 10 percent of intra-cranical tumors.The detecting the change of pituitary hormone after tumor excision aims to make groups of pituitary adenoma before operation and to detect the postopera-tional pituitary as well as to suit an effective method to decide the degrees of tumor removal and reoccour after operation.
METHODS Among 50 patients with pituitary hormone, the analysis of the value of pituitary hormone is reviewed retrospectively, according to the degree of tumor removal . The values of pituitary hormone on each group between preoperation and postoperation are analysed by t-test of paired samples. The values of postoperation pituitary hormone between two groups are analysed by t-test of mean of two samples. The clinical significant of relationship between the degree of tumor removal and the values of pituitary hormone is di scovered.
RESULTS The values of pituitary hormone after operation are decrease significantly after both complete and uncomplete tumor removal in PRL adenomas as well as GH adenomas (P<0. 05) , which shows operations
can correct the disturbance of endocrine. After comparing the values of pituitary hormone between the complete group and the uncomplete group, there is significant difference which shows the degrees of tumor removal affect the values of pituitary hormone after operation (P<0.05).
CONCLUSION The higher level of pituitary hormone can be cut down by operat ion,which demonstrates operation can' t be rep 1 ac ed. "In1 dei;reeof tumor removal plays an role in the change o em ocrine, which shows pituitary adenomas must be completely excised based on not injurying the normal pituitary tissues.
PURPOSE There is correlation between the degree of tumor removal and the correction of endocrine. The detection of endocrine hormone can he used to evalue the effciacy of operation,which plays an important role in clinical treatment of pituitary adenomas ami prognosis.
引文
1．王忠诚．神经外科学．湖北出版社，1997，489-506
2．张春芳，范虹．垂体手术对内分泌激素的影响．首都医科大学学报，1999，6：99-102
3. Thapar K, Horvath E, Muller PJ. Pituitary adenomas: recent advances in classification, histopatholory and molecular biology. Diagn Oncol, 1992,2:145
4. Wilson CB. A decade of pituitary microsurgery. Neurosurg, 1984,61:814
5. Flier JS, Vnderhill LH. Diagnsis and management of hormone secreting pituitary adenoma. N Engl J Med, 1991,324:822
6. Tindall GT, Barrow DL, Tindall SC. Current management of pituitary tumors. Emory Uuiversity Journal of Medicine, 1989,3:197
7. Flier JS, Vnderhill LH. Diagnsis and management of hormone secreting pituitary adenoma. N Engl J Med, 1991,324:822
8. Tindall GT, Barrow DL, Tindall SC. Current management of pituitary tumors. Emory Uuiversity Journal of Medicine,1989,3:197
9. Feigenbaum SL, Downey DE, Wilson CB, et al. Trans-sphenoidal pituitary resection for preopertive diagnosis of prolactin secreting pituitary adenoma in women: Long term following-up. J Clin Endocrinol Metab, 1996,81(5):1711-1719
10. Arafah BM, Kailani SH, Neki KE, et al. Immediate recovery of pituitary macroadenomas. J Clin Endocrinol Metab, 1994, 79 (2)
11．杨树源，等．经蝶窦显微外科手术治疗垂体腺瘤的长期疗效观察．中华神经外科杂志，1997，2：72
12．赵雅度主译．垂体腺瘤，人民卫生出版社，1988年第一版，北京．123
13．贺晓生．经蝶入路垂体腺瘤切除术概况．1997，24(4)：189-192
14．赵继宗．向显微外科新高度——“锁孔”技术迈进．中国微侵袭外科杂志，2000，5：1-2
15．曹作为，史克珊，等．眶上“锁孔”入路切除鞍上肿瘤．中华神经外科杂志，2001，17(4)：249
16. Perneczky A, Muler-Forell W, van Linder E,et al. Keyhol-concept in neurosurgery: with endoscope-assisted micro-surgery and case studies. Stuttgat. New York :Thieme,1999:3-55
17. Adams CBT,Burke CW. Current modes of trentment ofpituitary tumors. Br J Neurosurg,1993,7:123
18．苏长保，任祖渊，王维钧，等．经蝶窦显微外科切除垂体生长激素腺瘤．中华神经外科杂志，1991，7(1)：14-17
19. Ross DA, Wilson CB. Results of transsphenoidal microsurgery for growth hormon-secreating adenoma in a series of 214 patients. J Neurosurg 1988;68:854
20. Laws ER. et al. Neurosurgical management of acromegaly results in 82 patients treated between 1972 and 1977. J Neurodsurg 1979; 50;454
21. Leavens ME,et al. Clinical and endocrinological evaluation of 16 acromegalic patient treated by transsphenoidal surgery. J Neruosurg 1977;47:853
22. Balagura S. et al. Acromegaly: analysis of 132 cases treated surgically. Neurosurg 1981,8:413
23. Hardy J. et al. Acromegaly surgical treatment by transsphenoidal microsurgical removal of pituitary adenoma. In:Tindall. Collins. Eds. Clinical management of pituitary disorders. New York: Raven Press. 1979;209
24. UHS.et al. Transsphenoidal microhypophysiectomy in acromegaly. J Neurosurg 1977; 47; 840
25．丰育功，吴国庆，王伟民．经翼点入路切除鞍区肿瘤．中华神经外科杂志，2002，18(1)：69
26. Raubut R, Clar HE, Bamberg M, et al. Diagnostic criteria in pituitary tumor recurrence-combined modality of surgery and radiotherapy. Acta Neurochir,1986, 80:73
2．张春芳，范虹．垂体手术对内分泌激素的影响．首都医科大学学报，1999，6：99-102
3. Thapar K, Horvath E, Muller PJ. Pituitary adenomas: recent advances in classification, histopatholory and molecular biology. Diagn Oncol, 1992,2:145
4. Wilson CB. A decade of pituitary microsurgery. Neurosurg, 1984,61:814
5. Flier JS, Vnderhill LH. Diagnsis and management of hormone secreting pituitary adenoma. N Engl J Med, 1991,324:822
6. Tindall GT, Barrow DL, Tindall SC. Current management of pituitary tumors. Emory Uuiversity Journal of Medicine, 1989,3:197
7. Flier JS, Vnderhill LH. Diagnsis and management of hormone secreting pituitary adenoma. N Engl J Med, 1991,324:822
8. Tindall GT, Barrow DL, Tindall SC. Current management of pituitary tumors. Emory Uuiversity Journal of Medicine,1989,3:197
9. Feigenbaum SL, Downey DE, Wilson CB, et al. Trans-sphenoidal pituitary resection for preopertive diagnosis of prolactin secreting pituitary adenoma in women: Long term following-up. J Clin Endocrinol Metab, 1996,81(5):1711-1719
10. Arafah BM, Kailani SH, Neki KE, et al. Immediate recovery of pituitary macroadenomas. J Clin Endocrinol Metab, 1994, 79 (2)
11．杨树源，等．经蝶窦显微外科手术治疗垂体腺瘤的长期疗效观察．中华神经外科杂志，1997，2：72
12．赵雅度主译．垂体腺瘤，人民卫生出版社，1988年第一版，北京．123
13．贺晓生．经蝶入路垂体腺瘤切除术概况．1997，24(4)：189-192
14．赵继宗．向显微外科新高度——“锁孔”技术迈进．中国微侵袭外科杂志，2000，5：1-2
15．曹作为，史克珊，等．眶上“锁孔”入路切除鞍上肿瘤．中华神经外科杂志，2001，17(4)：249
16. Perneczky A, Muler-Forell W, van Linder E,et al. Keyhol-concept in neurosurgery: with endoscope-assisted micro-surgery and case studies. Stuttgat. New York :Thieme,1999:3-55
17. Adams CBT,Burke CW. Current modes of trentment ofpituitary tumors. Br J Neurosurg,1993,7:123
18．苏长保，任祖渊，王维钧，等．经蝶窦显微外科切除垂体生长激素腺瘤．中华神经外科杂志，1991，7(1)：14-17
19. Ross DA, Wilson CB. Results of transsphenoidal microsurgery for growth hormon-secreating adenoma in a series of 214 patients. J Neurosurg 1988;68:854
20. Laws ER. et al. Neurosurgical management of acromegaly results in 82 patients treated between 1972 and 1977. J Neurodsurg 1979; 50;454
21. Leavens ME,et al. Clinical and endocrinological evaluation of 16 acromegalic patient treated by transsphenoidal surgery. J Neruosurg 1977;47:853
22. Balagura S. et al. Acromegaly: analysis of 132 cases treated surgically. Neurosurg 1981,8:413
23. Hardy J. et al. Acromegaly surgical treatment by transsphenoidal microsurgical removal of pituitary adenoma. In:Tindall. Collins. Eds. Clinical management of pituitary disorders. New York: Raven Press. 1979;209
24. UHS.et al. Transsphenoidal microhypophysiectomy in acromegaly. J Neurosurg 1977; 47; 840
25．丰育功，吴国庆，王伟民．经翼点入路切除鞍区肿瘤．中华神经外科杂志，2002，18(1)：69
26. Raubut R, Clar HE, Bamberg M, et al. Diagnostic criteria in pituitary tumor recurrence-combined modality of surgery and radiotherapy. Acta Neurochir,1986, 80:73