病理未能证实垂体腺瘤库欣病的手术疗效(附61例分析)

目的探讨病理结果阴性库欣病的经蝶窦显微外科手术疗效。方法回顾性分析61例病理结果阴性库欣病的临床资料。本组均有典型的皮质醇增多症临床表现;内分泌检查符合库欣病48例,不典型13例;术前MRI诊断为微腺瘤33例,未见异常28例。行经蝶窦入路微腺瘤切除加瘤周垂体组织部分切除31例,垂体前叶部分切除30例。随访1.5～10年,平均3.3年。结果病理为垂体增生31例,其中Crooke细胞呈结节样增生17例;垂体前、后叶组织30例。本组治愈19例(31.2%),缓解16例(26.2%),无效26例(42.6%);有明显皮质醇功能低下表现者17例。术后行垂体放疗8例,肾上腺切除9例。结论病理未能发现肿瘤组织库欣病的疗效低于有明确腺瘤者。垂体放疗或肾上腺切除可以做为手术无效者的二线治疗方法。

Surgical efficacy of Cushing''''s disease pathologically unconfirmed pituitary adenoma: analysis of 61 cases

Objective To explore the surgical efficacy of transsphenoidal microsurgery for Cushing's disease with negative pathological results. Methods Clinical data of 61 cases of Cushing's disease with negative pathological results were analyzed retrospectively. All the patients had typical clinical manifestations consistent with hypercortisolism. Endocrinological assessment supported the diagnosis of Cushing's disease in 48 cases, and atypical endocrine data were found in 13. MRI showed microadenoma in 33 patients, and normal in 28. Transsphenoidal surgery was underwent in all patients, with selective microadenomectomy accompanied by removal of a part of normal pituitary tissue near the tumor in 31 cases, and partial resection of the adenohypophysis in 30. Follow-up period was from 1.5 to 10 years, averaging 3.3 years. Results Histological examination revealed pituitary ACTH cell hyperplasia in 31 cases including Crooke cell nodelike hyperplasia in 17, and normal pituitary anterior or posterior lobe tissue in 30. Clinical manifestations of hypocortisolism existed in 17 cases. In the series of patients, 19 (31.1%) achieved clinical cure, 16 (26.2%) remission, and 26 (42.6%) had no change. Pituitary radiosurgery was used in 8 cases, while adrenalectomy in 9. Conclusion The clinical efficacy of surgical treatment for Cushing's disease with negative pathological results is inferior to that with positive results. Pituitary radiotherapy or adrenalectomy can be chosen as second line therapy for patients with surgical failure.