神经内镜下库欣病经蝶入路手术治疗疗效（附18例分析）
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摘要
目的:评价神经内镜下库欣病经蝶入路手术治疗的疗效并探讨如何提高库欣病治疗的缓解率。方法:回顾性分析我科2007年7月至2010年3月开展神经内镜手术以来,经蝶入路手术治疗的18例库欣病患者的术后、随访期的临床表现、内分泌检查结果,评价患者的早期缓解率、早期并发症及随访期缓解率及并发症发生率。结果:16例患者表现为术后早期完全缓解,1例患者仅表现为部分缓解,1例无效者进一步行伽马刀治疗。随访期中,17例患者均表现为完全缓解,垂体放疗者呈部分缓解。结论:经蝶手术是治疗库欣病的最佳方法,围手术期可以通过多种途径有效地提高库欣病治疗的缓解率,神经内镜的成熟应用使得经蝶手术治疗库欣病的方法更加优化。
Objective: To evaluate surgical treatment efficacy of Cushing’disease under the neuro-endoscopy by transsphenoidal approach and to investigate how to raise remission rate of Cushing’disease treatment. Methods: Retrospectively analyzed clinical manifest- tation and endocrine examination of postoperative and follow-up period of 18 cases with Cushing’disease under the neuro-endoscopy by transsphenoidal approach from July 2007 to March 2010 in my neurosurgery department and assessed early- remission and complication as well as the remission and complication in follow-up period. Results: 16 cases present total-early-remission. 1 cases present only part-remission, 1 case present inefficacy and accepts Gamma Knife surgery. during follow-up period, 17 cases obtain satisfactorily total-remission, the case who accepted Gamma Knife surgery obtain part-remission. Conclusion: Transsphenoidal surgery is the preferred treatment modality for Cushing’disease. we can efficaciously raise remission rate of Cushing’disease treatment by many ways surrounding the operations. the proficiency of neuro-endoscope therapy mades transsphenoidal surgery treatment for Cushing’disease optimized.
Objective: To evaluate surgical treatment efficacy of Cushing’disease under the neuro-endoscopy by transsphenoidal approach and to investigate how to raise remission rate of Cushing’disease treatment. Methods: Retrospectively analyzed clinical manifest- tation and endocrine examination of postoperative and follow-up period of 18 cases with Cushing’disease under the neuro-endoscopy by transsphenoidal approach from July 2007 to March 2010 in my neurosurgery department and assessed early- remission and complication as well as the remission and complication in follow-up period. Results: 16 cases present total-early-remission. 1 cases present only part-remission, 1 case present inefficacy and accepts Gamma Knife surgery. during follow-up period, 17 cases obtain satisfactorily total-remission, the case who accepted Gamma Knife surgery obtain part-remission. Conclusion: Transsphenoidal surgery is the preferred treatment modality for Cushing’disease. we can efficaciously raise remission rate of Cushing’disease treatment by many ways surrounding the operations. the proficiency of neuro-endoscope therapy mades transsphenoidal surgery treatment for Cushing’disease optimized.
引文
[1]许志勤,苏长保,任祖渊,等. 102例垂体泌乳素微腺瘤经蝶显微手术疗效[J].中华神经外科杂志, 2007, 23 (9):659-661.
[2]惠国帧,王清,吴智远,等.老年无功能垂体腺瘤的外科治疗[J].中华神经外科杂志, 2003, 19 (1):34-36.
[3]刘丕楠,王忠诚,张亚卓,等.内镜下经鼻腔-蝶窦入路垂体瘤切除术[J].中华神经外科杂志, 2001, 17 (14):220-222.
[4]陈革,凌锋,张秋航,等.内镜下经鼻蝶入路垂体瘤切除术[J].中华神经外科疾病研究杂志, 2006, 5 (3):212-214.
[5] Dickerman RD, Oldfield EH.Basis of persistent and recurrent Cushing disease:ana nalysis of findings at repeated pituitary surgery [J].Neurosurg ,2002,97:1343-1349.
[6] Ram Z, Cohen ZR, Hadani M. Transsphenoidal surgery for Cushing’s dis ease:endocrinological follow-up monitoring of 82 patients[J]. Neurosurgery, 2002, 51:57–62.
[7]刘岳,舒凯,韩林,等. 25例垂体ACTH腺瘤的临床分析[J].中国临床神经外科杂志, 2007, 12:521-524.
[8] Jankowski R, Auque J, Simon C, et al. Endoscopic pituitary tumor surgery[J]. Laryngoscope, 1992, 102:198–202.
[9] Moshang T Jr. Cushing’s disease, 70 years later and the beat goes on [J]. Clin Endocrinol Metab, 2003, 88:31-33.
[10]Reitmeyer M, Vance ML, Laws ER, et al. The neurosurgical management of Cushing's disease[J]. Mol Cell Endocrinol, 2002, 197:73-79.
[11]Cappabianca P, Cavallo LM, Colao A, et al. Endoscopic endonasal transsphenoidal approach:outcome analysis of 100 consecutive procedures[J]. Minim Invasive Neurosurg, 45:193–200, 2002.
[12]ho HD. Endoscopictranssphenoidal surgery[J]. Neuroonco, 2001, l54:187-195.
[13]Netea-Maier RT, van Lindert EJ, den Heijer M, et al:Transsphenoidal pituitary surger via the endoscopic technique:results in 35 consecutive patient with Cushing’s disease[J]. Eur Endocrinol, 2006, 154:675–684.
[14]Frank G, Pasquini E, Farneti G, et al. The endoscopic versus the traditional approach in pituitary surgery[J]. Neuroendocrinology, 2006, 83:240–248.
[15]张亚卓,王忠诚,刘业剑,等.内镜经鼻蝶入路手术治疗垂体瘤.[J]中国微侵袭神经外科杂志, 2007, 12 (2)∶51-54.
[16]Armand krikorian, Dima abdelmannan, Warrenr selman , et al. Cushing disease:use of perioperative serum cortisol measurements in early determination of success following pituitary surgery[J]. Neurosurg Focus, 2007, 23 (3):E6.
[17]Nathane E, Simmons M. D, TORD D, et al. Serum cortisol response to transsphenoidal surgery for Cushing disease[J]. Neurosurg, 2001, 95:1–8.
[18]Dyer EH, Civit T, Visot A, et al. Transsphenoidal surgery for pituitary adenomas in children[J]. Neurosurgery, 1994, 34:207–212.
[19]卞留贯,孙青芳,沈建康,等.垂体Cushing病的经蝶手术治疗(附54例报告) [J].中国神经精神疾病杂志, 2008, 7 (34) :393-396.
[20]Nathan E, Simmons M D, Tord D, et al. Serum cortisol response to transsphenoidal surgery for Cushing disease[J]. Neurosurg, 2001, 95:1-8.
[21]Cappabianca P, Cavallo LM, Colao A, Divitiis E. Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas[J]. J Neurosurg, 2002, 97:293-298.
[22]Chirag G, Edward R. Laws JR, et al. National trends, complications, and outcomes following transsphenoidal surgery for Cushing’s disease from 1993to2002[J]. Neurosurg Focus, 2007, 23 (3):E7.
[23]Jagannathan J, Sheehan JP, Jane JA. Evaluation and management of Cushing in cases of negative magnetic resonance imaging[J] Neurosurg Focus, 2007, 23 (3):E31-7.
[24]Oldfield EH, Vortmeyer AO. Development of a histological pseudo capsule and its use as a surgical capsule in the excision of pituitary tumors[J]. Neurosurg, 2006, 104 (1) :7-19.
[25]Bradley A, Gross B. S. , stefan A, et al. Medical management of Cushing disease- [J].Neurosurg Focus, 2007, 23 (3):E10.
[26]Tatsuya kobayashi, yoshihisa KIDA, et al. Gamma knife radiosurgery in the treatment of Cushing disease:long-term results[J]. J Neurosurg (Suppl 5) , 2002, 97:422-428
[27]Bernd M. Hofmann, Michal Hlavac, et al. surgical treatment of recurrent Cushing disease[J]. neurosurgery, 2006, 6 (58):1108-1118.
[28]幸兵,张楠,任祖渊,等.肾上腺切除在库欣病治疗中的作用[J].中华外科杂志, 2008, 46 (8):592-594.
[29]H?ybye C, Grenb?ck E, Thorén M, et al. Transsphenoidal surgery in Cushing disease:10 years of experience in 34 consecutive cases[J]. Neurosurg, 2004, 100:634–638.
[30]Charlotte H?ybye, Eva Grenb?ck, et al. adrenocorticotropic hormone-producingpituitary tumors:12- to 22-year follow-up after treatment with stereotactic radiosurgery[J]. Neurosurgery, 2001, 49 (2):284-292.
[31]Chee GH, Mathias DB, James RA, et al. Transsphenoidal pituitary surgery in Cushing’s disease:can we predict outcome?[J]. ClinEndocrinol ( Oxf) , 2001, 54 (5) :617-626.
[32]王爱萍,汪寅章,盖红波,王雪琴,等.库欣病:垂体大腺瘤与微腺瘤的比较[J].中华内分泌代谢杂志, 2001, 17 (3):154-157.
[33]Paolo Cappabianca, Luigi Maria Cavallo, et al. Endoscopic endonasal transsphenoidal surgery[J]. Neurosurgery, 2004, 55 (4):933-940.
[34]Amir R. Dehdashti,Ahmed Ganna, Konstantina Karabatsou,et al. Pure endoscopic endonasal approach for pituitary adenomas:early surgical results in 200 patients and comparison with previous microsurgical series[J]. Neurosurgery, 2008, 62 (5):1006-1015.
[35]Enrico de Divitiis MD. Endoscopic transsphenoidal surgery:stone-in-the-pond effect[J]. Neurosurgery, 2006, 59 (3):512-517.
[36]Stefan Wolfsberger MD, AndréNeubauer, PhD, Katja Bühler, PhD, et al. Advanced- virtual endoscopy for endoscopic transsphenoidal pituitary surgery [J]. Neurosurgery,2006, 59 (5):1001-1009.
[1] Morris D,Grossman A.The medical management of Cushing’s syndrome.Ann N Y Acad Sci,2002,97:119-133.
[2]夏学巍,苏长保,任祖渊,等.库欣病经蝶手术复发的影响因素.中国医学科学院学报,2006,28(3):415-417.
[3]钟跃,杨新宇,杨树源.垂体ACTH腺瘤的诊断和治疗(附29例报告).中华神经外科杂志,2002,18(3):178-180.
[4]张维天,刘芳,陈正侬,等.内镜经蝶手术治疗鞍区MRI阴性的库欣病1例并文献复习,2009,15(3):214-216.
[5]张天锡,赵卫国.浅谈库欣病诊治中的误区.中华神经外科疾病研究杂志,2005,4(4):289-292.
[6]雷霆,舒凯,李龄.垂体腺瘤的诊断与治疗.临床内科杂志,2008,25(9):581-583.
[7] Newell-Price J, Bertagna X, Grossman AB, et al. Cushing’s syndrome. Lan- cet,2006,367:1605-1617.
[8] Vilar L,Coelho CE. Diagnosis and differential diagnosis of Cushing’s syndrome /Vilar L,Kater CE,Naves LA,et al.(eds).Clinical Endocrinology.3 rd ed . Rio de Jane- iro:Guanabara Koogan,2006:397-417.
[9] Swearingen B,Katznels on L,Miller K,et al.Diagnostic errors after inferi or petrosal sinus samp ling. Clin EndocrinolMetab,2004,89:3752-3763.
[10]Kaltsas GA,Giannulisn MG,Newell-Price JD. A critical analysis of the value of simultaneous inferior petrosal sinus sampling in Cushing’s disease and the occu ltectopic adrenocorticotrop in syndrome. Clin Endocrinol Metab,1999,84(2):487.
[11]Graham KE. Caveners sinus sampling is high accurate in distinguishing Cushing’s disease from ectopic Cushing’s syndrome and in predicting intrapituitary tumor location. Clin Endocrinol Metab,1999,84(5):760.
[12]胡仁明.内分泌代谢病临床新技术.北京:人民军医出版社,2002:70-95.
[13]Newell-Price J,Perry L,Medbak S,et al.A combined test using desmopressin and corticotropin-releasing hormones in the differential diagnosis of Cushing's syndrome. Clin Endocrinol Metab,1997,82(3):176-181.
[14]陆召麟,郭爱丽,张洁萍,等.20例异位ACTH综合征的诊断和治疗.中华内分泌代谢杂志,1999,15(6):331-334.
[15]巴德年.当代医学新理论与新技术丛书,临床医学卷.哈尔滨:黑龙江科技出版社,2000:670-684.
[16]黄日方,胡仁明,陈家伦,等.异位ACTH综合征与垂体性库欣病的鉴别诊断.国外医学内分泌学分册,2001,21(2):85-88.
[17]徐兆平,王浩飞,张祖豹,等.异位ACTH肿瘤的诊断和治疗.上海第二医科大学学报,2001,21(4):369-371.
[18]沈晓黎,雷霆,舒凯.MRI推断垂体腺瘤质地?侵袭性与经蝶入路术中所见的比较.中国耳鼻咽喉颅底外科杂志,2004,28(2):10-14.
[19]王琪.垂体腺瘤的诊断和治疗进展.国外医学耳鼻咽喉科学分册,2005,29(1):437-439.
[20]幸兵,李永宁,任祖渊,等.垂体促肾上腺皮质激素腺瘤的MRI特点.中国医学影像学杂志,2008,16(4):249-251.
[21]orris D,Grossman A.The medical management of Cushing’s syndrome.Ann N Y Acad Sci,2002,97:119-133.
[22]周波,周涛,黄书岚.垂体腺瘤经单鼻孔内镜下切除.中华神经外科疾病研究杂志,2003,2(4):315-317.
[23]张天锡.垂体腺瘤术后治疗探讨.临床外科杂志,2004,12(4):202-203 .
[24]王晓淡,陈克敏.库欣病的垂体影像学评价.国外医学内分泌学.2005, 25(2): 137-139.
[25]姜兰叶,钟历勇.库欣综合征1例并文献复习.实用医学杂志,2007, 23(7): 1008-1010.
[26]杨义,任祖渊,苏长保,等.库欣病经蝶术后复发的诊断和治疗策略.中华神经外科杂志,2005,21(3):142-145.
[27]bradley A,Gross B.S.,stefan A,et al.Medical management of Cushing disease. Neurosurg Focus,2007,23(3):E10.
[28] tatsuya kobayashi,yoshihisa KIDA,et al.Gamma knife radiosurgery in the treatment of Cushing disease:long-term results.J Neurosurg(Suppl 5),2002,97:422-428
[29]幸兵,张楠任祖渊,等.肾上腺切除在库欣病治疗中的作用.中华外科杂志,2008,46(8):592-594.
[2]惠国帧,王清,吴智远,等.老年无功能垂体腺瘤的外科治疗[J].中华神经外科杂志, 2003, 19 (1):34-36.
[3]刘丕楠,王忠诚,张亚卓,等.内镜下经鼻腔-蝶窦入路垂体瘤切除术[J].中华神经外科杂志, 2001, 17 (14):220-222.
[4]陈革,凌锋,张秋航,等.内镜下经鼻蝶入路垂体瘤切除术[J].中华神经外科疾病研究杂志, 2006, 5 (3):212-214.
[5] Dickerman RD, Oldfield EH.Basis of persistent and recurrent Cushing disease:ana nalysis of findings at repeated pituitary surgery [J].Neurosurg ,2002,97:1343-1349.
[6] Ram Z, Cohen ZR, Hadani M. Transsphenoidal surgery for Cushing’s dis ease:endocrinological follow-up monitoring of 82 patients[J]. Neurosurgery, 2002, 51:57–62.
[7]刘岳,舒凯,韩林,等. 25例垂体ACTH腺瘤的临床分析[J].中国临床神经外科杂志, 2007, 12:521-524.
[8] Jankowski R, Auque J, Simon C, et al. Endoscopic pituitary tumor surgery[J]. Laryngoscope, 1992, 102:198–202.
[9] Moshang T Jr. Cushing’s disease, 70 years later and the beat goes on [J]. Clin Endocrinol Metab, 2003, 88:31-33.
[10]Reitmeyer M, Vance ML, Laws ER, et al. The neurosurgical management of Cushing's disease[J]. Mol Cell Endocrinol, 2002, 197:73-79.
[11]Cappabianca P, Cavallo LM, Colao A, et al. Endoscopic endonasal transsphenoidal approach:outcome analysis of 100 consecutive procedures[J]. Minim Invasive Neurosurg, 45:193–200, 2002.
[12]ho HD. Endoscopictranssphenoidal surgery[J]. Neuroonco, 2001, l54:187-195.
[13]Netea-Maier RT, van Lindert EJ, den Heijer M, et al:Transsphenoidal pituitary surger via the endoscopic technique:results in 35 consecutive patient with Cushing’s disease[J]. Eur Endocrinol, 2006, 154:675–684.
[14]Frank G, Pasquini E, Farneti G, et al. The endoscopic versus the traditional approach in pituitary surgery[J]. Neuroendocrinology, 2006, 83:240–248.
[15]张亚卓,王忠诚,刘业剑,等.内镜经鼻蝶入路手术治疗垂体瘤.[J]中国微侵袭神经外科杂志, 2007, 12 (2)∶51-54.
[16]Armand krikorian, Dima abdelmannan, Warrenr selman , et al. Cushing disease:use of perioperative serum cortisol measurements in early determination of success following pituitary surgery[J]. Neurosurg Focus, 2007, 23 (3):E6.
[17]Nathane E, Simmons M. D, TORD D, et al. Serum cortisol response to transsphenoidal surgery for Cushing disease[J]. Neurosurg, 2001, 95:1–8.
[18]Dyer EH, Civit T, Visot A, et al. Transsphenoidal surgery for pituitary adenomas in children[J]. Neurosurgery, 1994, 34:207–212.
[19]卞留贯,孙青芳,沈建康,等.垂体Cushing病的经蝶手术治疗(附54例报告) [J].中国神经精神疾病杂志, 2008, 7 (34) :393-396.
[20]Nathan E, Simmons M D, Tord D, et al. Serum cortisol response to transsphenoidal surgery for Cushing disease[J]. Neurosurg, 2001, 95:1-8.
[21]Cappabianca P, Cavallo LM, Colao A, Divitiis E. Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas[J]. J Neurosurg, 2002, 97:293-298.
[22]Chirag G, Edward R. Laws JR, et al. National trends, complications, and outcomes following transsphenoidal surgery for Cushing’s disease from 1993to2002[J]. Neurosurg Focus, 2007, 23 (3):E7.
[23]Jagannathan J, Sheehan JP, Jane JA. Evaluation and management of Cushing in cases of negative magnetic resonance imaging[J] Neurosurg Focus, 2007, 23 (3):E31-7.
[24]Oldfield EH, Vortmeyer AO. Development of a histological pseudo capsule and its use as a surgical capsule in the excision of pituitary tumors[J]. Neurosurg, 2006, 104 (1) :7-19.
[25]Bradley A, Gross B. S. , stefan A, et al. Medical management of Cushing disease- [J].Neurosurg Focus, 2007, 23 (3):E10.
[26]Tatsuya kobayashi, yoshihisa KIDA, et al. Gamma knife radiosurgery in the treatment of Cushing disease:long-term results[J]. J Neurosurg (Suppl 5) , 2002, 97:422-428
[27]Bernd M. Hofmann, Michal Hlavac, et al. surgical treatment of recurrent Cushing disease[J]. neurosurgery, 2006, 6 (58):1108-1118.
[28]幸兵,张楠,任祖渊,等.肾上腺切除在库欣病治疗中的作用[J].中华外科杂志, 2008, 46 (8):592-594.
[29]H?ybye C, Grenb?ck E, Thorén M, et al. Transsphenoidal surgery in Cushing disease:10 years of experience in 34 consecutive cases[J]. Neurosurg, 2004, 100:634–638.
[30]Charlotte H?ybye, Eva Grenb?ck, et al. adrenocorticotropic hormone-producingpituitary tumors:12- to 22-year follow-up after treatment with stereotactic radiosurgery[J]. Neurosurgery, 2001, 49 (2):284-292.
[31]Chee GH, Mathias DB, James RA, et al. Transsphenoidal pituitary surgery in Cushing’s disease:can we predict outcome?[J]. ClinEndocrinol ( Oxf) , 2001, 54 (5) :617-626.
[32]王爱萍,汪寅章,盖红波,王雪琴,等.库欣病:垂体大腺瘤与微腺瘤的比较[J].中华内分泌代谢杂志, 2001, 17 (3):154-157.
[33]Paolo Cappabianca, Luigi Maria Cavallo, et al. Endoscopic endonasal transsphenoidal surgery[J]. Neurosurgery, 2004, 55 (4):933-940.
[34]Amir R. Dehdashti,Ahmed Ganna, Konstantina Karabatsou,et al. Pure endoscopic endonasal approach for pituitary adenomas:early surgical results in 200 patients and comparison with previous microsurgical series[J]. Neurosurgery, 2008, 62 (5):1006-1015.
[35]Enrico de Divitiis MD. Endoscopic transsphenoidal surgery:stone-in-the-pond effect[J]. Neurosurgery, 2006, 59 (3):512-517.
[36]Stefan Wolfsberger MD, AndréNeubauer, PhD, Katja Bühler, PhD, et al. Advanced- virtual endoscopy for endoscopic transsphenoidal pituitary surgery [J]. Neurosurgery,2006, 59 (5):1001-1009.
[1] Morris D,Grossman A.The medical management of Cushing’s syndrome.Ann N Y Acad Sci,2002,97:119-133.
[2]夏学巍,苏长保,任祖渊,等.库欣病经蝶手术复发的影响因素.中国医学科学院学报,2006,28(3):415-417.
[3]钟跃,杨新宇,杨树源.垂体ACTH腺瘤的诊断和治疗(附29例报告).中华神经外科杂志,2002,18(3):178-180.
[4]张维天,刘芳,陈正侬,等.内镜经蝶手术治疗鞍区MRI阴性的库欣病1例并文献复习,2009,15(3):214-216.
[5]张天锡,赵卫国.浅谈库欣病诊治中的误区.中华神经外科疾病研究杂志,2005,4(4):289-292.
[6]雷霆,舒凯,李龄.垂体腺瘤的诊断与治疗.临床内科杂志,2008,25(9):581-583.
[7] Newell-Price J, Bertagna X, Grossman AB, et al. Cushing’s syndrome. Lan- cet,2006,367:1605-1617.
[8] Vilar L,Coelho CE. Diagnosis and differential diagnosis of Cushing’s syndrome /Vilar L,Kater CE,Naves LA,et al.(eds).Clinical Endocrinology.3 rd ed . Rio de Jane- iro:Guanabara Koogan,2006:397-417.
[9] Swearingen B,Katznels on L,Miller K,et al.Diagnostic errors after inferi or petrosal sinus samp ling. Clin EndocrinolMetab,2004,89:3752-3763.
[10]Kaltsas GA,Giannulisn MG,Newell-Price JD. A critical analysis of the value of simultaneous inferior petrosal sinus sampling in Cushing’s disease and the occu ltectopic adrenocorticotrop in syndrome. Clin Endocrinol Metab,1999,84(2):487.
[11]Graham KE. Caveners sinus sampling is high accurate in distinguishing Cushing’s disease from ectopic Cushing’s syndrome and in predicting intrapituitary tumor location. Clin Endocrinol Metab,1999,84(5):760.
[12]胡仁明.内分泌代谢病临床新技术.北京:人民军医出版社,2002:70-95.
[13]Newell-Price J,Perry L,Medbak S,et al.A combined test using desmopressin and corticotropin-releasing hormones in the differential diagnosis of Cushing's syndrome. Clin Endocrinol Metab,1997,82(3):176-181.
[14]陆召麟,郭爱丽,张洁萍,等.20例异位ACTH综合征的诊断和治疗.中华内分泌代谢杂志,1999,15(6):331-334.
[15]巴德年.当代医学新理论与新技术丛书,临床医学卷.哈尔滨:黑龙江科技出版社,2000:670-684.
[16]黄日方,胡仁明,陈家伦,等.异位ACTH综合征与垂体性库欣病的鉴别诊断.国外医学内分泌学分册,2001,21(2):85-88.
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