手术治疗121例老年垂体腺瘤临床分析

目的 探讨老年垂体腺瘤的临床特点和手术治疗意义.方法 回顾性分析了121例60岁及以上垂体腺瘤的临床资料.结果 手术主要采用经鼻蝶窦入路,肿瘤全切除及次全切除91例,大部切除25例,部分切除5例.住院期间视力好转80例,占88.9％.随访MRI72例,肿瘤无复发或静止状态67例,复发需再次手术5例.术后生活自理率80％.结论 多数老年垂体腺瘤初期的临床表现隐匿,发现时往往肿瘤大、压迫视神经,尽早鞍区MRI检查可明确诊断.手术切除肿瘤对老年垂体瘤有效、安全,尤其是经鼻蝶入路.     

垂体瘤的诊断、鉴别诊断与治疗——常见垂体腺瘤的临床诊断

垂体腺瘤是发生于腺垂体的良性肿瘤，占中枢神经系统肿瘤的10％～20％，是颅内最常见的肿瘤之一。根据免疫组织化学将垂体腺瘤按功能进行分类，主要有激素分泌活性腺瘤和非激素分泌活性腺瘤两大类。前者包括生长激素瘤(GH腺瘤)、催乳素瘤(PRL腺瘤)、促肾上腺皮质素瘤(ACTH腺瘸)、Nelson综合征、促甲状腺素瘤(TSH腺瘤)、促性腺素瘤(FSH和LH腺瘤)；后者包括无功能细胞腺瘤。现将临床比较     

老年垂体腺瘤的微侵袭治疗

目的 探讨老年垂体腺瘤患者行经蝶垂体腺瘤切除术的安全性及有效性.方法 回顾性分析21例行经蝶手术治疗的老年垂体腺瘤患者的临床资料.结果 经蝶垂体腺瘤切除术后,71.4％的头痛患者及70％视力改变的患者症状得到明显改善,1例患者围术期死亡.在随访的18例患者中,有14例行MRI检查未见肿瘤复发,1例术后泌乳素增高,口服溴隐亭治疗.术后均无严重近期及远期并发症.结论 在充分的术前准备、精细的手术操作及良好的围术期管理情况下,经蝶垂体腺瘤切除术安全有效,可作为老年垂体腺瘤患者的首选治疗方式.     

老年垂体腺瘤患者PTTG表达和MVD计数与垂体腺瘤侵袭性的关系

垂体腺瘤是由于垂体前叶腺细胞单克隆增生而形成的腺瘤,是较常见的颅内肿瘤,约占所有颅内肿瘤的10%～15%。根据垂体腺瘤的生物学行为,可将其分为侵袭性和非侵袭性垂体腺瘤,侵袭性垂体腺瘤的生物学行为介于良性与恶性腺瘤之间,可破坏并侵袭患者鞍区骨质和海绵窦等鞍区结构,具有治     

垂体腺瘤的诊断与治疗

垂体腺瘤是常见的良性肿瘤,人群发生率为1/100 000,约占颅内肿瘤的10%.且近年来随神经影像学和神经内分泌学的发展,发现并确诊为该病逐渐增多,发病率有增多的趋势.临床上已形成了以神经外科为中心的多学科合作治疗模式.随着基础和临床研究的不断深入,现代科学技术的突飞猛进,为垂体腺瘤这个古老的疾病诊治带来了新的"活力",同时对垂体外科治疗也提出了现代要求:力争全切肿瘤,保留残余正常垂体、恢复正常的激素水平和提高患者的生活质量.     

经蝶手术治疗大型及巨型垂体腺瘤140例临床观察

目的观察经蝶手术治疗大型、巨型垂体腺瘤的临床疗效。方法大型、巨型垂体腺瘤患者140例。采用（左）鼻中隔切口,切开鼻前庭小柱,经鼻中隔—蝶窦中线处凿开鞍底,切除肿瘤。结果 140例肿瘤行包膜内全切除48例,其余行次全切除或大部分切除。术后症状立即改善者122例,并发暂时性尿崩症20例、脑脊液（CSF）鼻漏18例、颅内感染5例、垂体功能低下1例。结论对于大型和巨型垂体腺瘤,经蝶手术治疗可获良好效果。     

老年人垂体腺瘤的微创手术

垂体腺瘤是常见的颅内良性肿瘤 ,发病率约十万分之一 ,占颅内肿瘤的 10 %。我院收治的垂体腺瘤占颅内肿瘤的 19 8% [1] 。近 2 0年来本科室经蝶微创手术切除垂体腺瘤 3375例 ,老年病人占 9 2 % ,国内外资料老年患者占 5 %～ 18% [2 ,3] 。1　老年垂体腺瘤的特点1 1　类型　根据我院 10年来收集的 190例老年垂体腺瘤 ,无分泌型腺瘤占 5 3 7% ,多激素腺瘤占2 1 1% ,泌乳素 (PRL)腺瘤和生长激素 (GH)腺瘤各占 11 6 % ,其他类型的肿瘤很少 ,无 1例为促甲状腺激素 (TSH)腺瘤和促肾上腺皮质激素(ACTH)腺瘤。这个比例和大宗资料或年轻病人的构…     

高龄垂体腺瘤28例临床分析

垂体腺瘤多发生于青壮年,70岁及以上人群中发病率相对较低[1,2 ].由于绝大多数高龄患者为无功能垂体腺瘤且为大腺瘤及巨大腺瘤,手术是治疗的首选方式.但手术本身存在一定的风险,同时高龄垂体腺瘤患者存在机体功能明显老化,且多数合并一种或几种其他系统疾病问题.如何把握肿瘤治疗及长期生存之间的关系,合理确定治疗方案,对此类病人的长期预后及正规诊治有重要的意义.本研究就高龄垂体腺瘤病人在临床及影像学上的特点,手术治疗风险及手术前后内分泌状况等问题进行回顾,为进一步规范化治疗提供依据.     

经鼻蝶窦入路显微手术治疗垂体腺瘤

目的 探讨经鼻蝶窦入路切除垂体腺瘤的显微手术治疗及术后处理.方法 回顾性分析经单鼻孔蝶窦入路显微手术切除的38例垂体微腺瘤患者的临床资料.38例垂体腺瘤中泌乳素( PRL)腺瘤18例,生长激素(GH)腺瘤12 例,促肾上腺皮质激素(ACTH)腺瘤5例, 无分泌功能腺瘤3例.结果 肿瘤全切33例, 次全切5例;术后复查激素水平,降至正常26例, 下降大于50%的4例, 8例变化不明显.结论 单鼻孔经蝶入路显微手术切除垂体腺瘤是一种安全、有效的方法.     

垂体肿瘤239例临床特征分析

目的 探讨垂体瘤的临床特征及治疗方案.方法 回顾性分析福建省立医院自1994年1月至2007年6月间收住的239例垂体瘤患者的临床资料.结果 239例垂体腺瘤中,男性93例(38.9%),女性146例(61.1%).诊断时的平均年龄为(43.8±14.9)岁(范围为3.9～77岁).依据临床表现、影像学及内分泌检查、免疫组织化学染色所示,催乳素瘤为最常见的肿瘤(26.8%).手术治疗179例(74.9%),其中经蝶入路108例(60.3%),经额入路71例(39.7%),非手术治疗及随访者60例(25.1%).结论 垂体瘤可表现为内分泌异常、神经系统症状或其他原因行MRI意外发现;催乳素瘤为最常见的肿瘤.     

Transcranial surgery for pituitary adenomas

Following a century of evolution and refinements in standard surgical techniques, the vast majority of operations for pituitary adenoma to date are performed utilizing transsphenoidal approaches. From current large series one obtains the impression that certainly less than 10% of these tumors require craniotomies. However, still several tumors, which’s volume is mainly localized outside of the sella require transcranial approaches, of which the pterional and subfrontal routes are the most widely used. The goal of surgical treatment is rapid eradication of the tumor mass, decompression of visual pathways and elimination of hormonal oversecretion whilst preserving the normal gland and avoiding potential surgical complications. Even with microsurgical techniques and standardized approaches, there is still some mortality associated with transcranial approaches and morbidity is undoubtly higher than with transsphenoidal operations. However, a selection bias must be considered, which shifts tumors with a larger size, less favourable prognosis and higher complication rate into the transcranial series. Moreover, with extended transsphenoidal approaches, lesions have become accessible for transsphenoidal surgery, which previously have been considered as contraindications. In this article current indications and limitations for transcranial surgery of pituitary adenomas, the preoperative workup, surgical techniques, results, and complications are briefly reviewed.     

凋亡抑制蛋白survivin在垂体腺瘤中的表达

采用免疫组织化学法检测survivin、bcl- 2蛋白在8例正常垂体组织及38例垂体腺瘤组织中的表达。结果提示survivin蛋白的表达阳性率与垂体腺瘤组织中的bcl -2蛋白表达密切相关,survivin蛋白表达异常引起的细胞凋亡抑制在垂体腺瘤的发生中起一定作用。     

Malignant pituitary corticotroph adenomas: report of two cases and a comprehensive review of the literature

Corticotroph pituitary carcinomas are tumors, defined by the presence of distant metastases that determine their poor prognosis. The diagnosis and therapy of malignant corticotroph adenomas remains a clinical challenge. The molecular mechanisms of malignant transformation of pituitary adenomas are unclear, although they are believed to arise in an adenoma-to-carcinoma sequence. We describe two cases of malignant Cushing’s disease with metastases in liver and bone, respectively. The primary pituitary tumors were treated by a combination of radiotherapy and transsphenoidal surgery, but recurred several times in both patients. The time interval between the diagnosis of Cushing’s disease and the discovery of metastases was 32 and 17 years, respectively. In the first case the patient died within 6 months after diagnosis of metastasis, whereas the second patient is alive at a follow-up of 2 years after the discovery of the metastasis. Furthermore, we reviewed all available cases of corticotroph pituitary carcinomas reported in the literature and analyzed their clinical features and therapeutical management. In conclusion, frequent relapses of Cushing’s disease, aggressive growth of macroadenoma, Nelson’s syndrome after adrenalectomy or persistently high ACTH levels should prompt the clinician to consider the possibility of pituitary corticotroph carcinomas. A. A. van der Klaauw and T. Kienitz contributed equally to this study.     

Somatostatin analogs in treatment of non-growth hormone-secreting pituitary adenomas

Besides well-known effects in GH-secreting adenomas, somatostatin analogs such as octreotide and lanreotide have been used in TSH-secreting adenomas and in the so-called clinically nonfunctioning adenomas. The rationale for their use is based on the evidence that both these tumor types express large amounts of somatostatin receptor subtypes 2 and 5, which are preferentially bound by octreotide and lanreotide. However, whether in TSH-secreting adenomas the results are excellent in the nonfunctioning type, the results are controversial. Some preliminary results showing a very rapid recovery of the visual field have not been confirmed subsequently. No evident effect of tumor shrinkage has been reported. At present, the use of somatostatin analogs in clinically nonfunctioning adenomas is questioned.     

垂体腺瘤患者的围手术期垂体激素监测及临床意义

为了对垂体腺瘤患者进行手术前后激素测定、分型、并监测术后垂体功能以及寻求一种判断手术切除程度及术后有无复发的方法，对50例垂体腺瘤手术患者采用放免法测定手术前、后激素水平，对测定值进行回顾性分析，判断检测结果的相互关系并分析其临床意义。结果：泌乳素(PRL)腺瘤及生长激素(GH)腺瘤全切组及末全切组术后激素水平均较术前明显降低(P＜0．05)，全切组术后激素水平与末全切组比较有明显差异(P＜0．05)。认为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。其切除程度将决定着术后内分泌的改善水平，应在不损害正常垂体前提下争取全切肿瘤。     

垂体腺癌的临诊应对

回顾性分析经病理证实的原发性垂体腺癌1例,结合影像学上肿瘤的侵袭性进展过程和临床特征进行分析.垂体腺癌生长迅速,肿瘤生长特点有助于临床诊断;其治疗方案与垂体腺瘤也有所不同.临床上,垂体肿瘤增长迅速并伴有侵袭性时需警惕垂体腺癌的可能性,针对垂体腺癌的临床诊疗,仍需进一步累积经验.     

垂体腺瘤增殖和凋亡指标与肿瘤侵袭性相关

目的 观察垂体腺瘤的细胞增殖以及凋亡特性.探讨肿瘤侵袭性的相关因素和早期诊断指标.方法对垂体瘤固定标本行Ki-67单克隆抗体染色,应用流式细胞仪对新鲜垂体瘤标本进行DNA倍体和细胞凋亡分析.结果固定标本48例,侵袭性腺瘤28例,Ki-67高表达率为13/28,非侵袭组高表达率为6/20,两者相比统计学差异明显(χ~2=5.486,P=0.019),高表达对侵袭性诊断的灵敏性为46.5%,阳性预测值为68.3%.新鲜垂体瘤标本33例,侵袭性腺瘤15例,非侵袭性18例,非侵袭组S期细胞比例为0.8%～12.2%,平均4.8%,侵袭组为3.9%～24.2%,平均13.0%,两者相比统计学差舁明显(t=3.745,P=0.001),高于13.0%侵袭性诊断的灵敏性为40%,阳性预测值为100%;凋亡细胞比例侵袭组5.1%～27.0%,平均12.5%,非侵袭组3.6%～30.3%,平均16.2%,两组相比无明显差异(t=1.25,P=0.22).S/A(增殖凋亡细胞比值)侵袭组1.411,非侵袭组0.399,两者相比统计学差异明显(t=4.62,P<0.01),S/A高于1.411侵袭性诊断的灵敏性为60%,阳性预测值为100%.结论侵袭性腺瘤和非侵袭性腺瘤有着不同比例的增殖细胞和凋亡细胞,高增殖状态对侵袭性的诊断灵敏性较低,增殖和凋亡细胞比例失衡对侵袭性则具有更高的灵敏性和特异性.     

Endoscopic pituitary surgery

Pituitary surgery is a continuous evolving speciality of the neurosurgeons’ armamentarium, which requires precise anatomical knowledge, technical skills and integrated appreciation of the pituitary pathophysiology. What we consider “pure” endoscopic transsphenoidal surgery is a procedure performed through the nose and the sphenoid bone, with the endoscope alone throughout the whole approach to visualize the surgical target area and without the use of any transsphenoidal retractor. It offers some advantages due to the endoscope itself: a superior close-up view of the relevant anatomy and an enlarged working angle are provided with an increased panoramic vision inside the surgical area. Concerning results in terms of mass removal, relief of clinical symptoms, cure of the underlying disease and complication rate, they are, at least, similar to those reported in the major microsurgical series, but patient compliance is by far better. Furthermore transsphenoidal endoscopy brings advantages to the patient (less nasal traumatism, no nasal packing, less post-op pain and usually quick recovery), to the surgeon (wider and closer view of the surgical target area, increase of the scientific activity as from the peer-reviewed literature on the topic in the last 10 years, smoothing of interdisciplinary cooperation), to the institution (shorter post-op hospital stay, increase of the case load). Besides, further progress and technological advance are expected from the close cooperation between different technologies and industries. Continuing works in such field of “minimalism” will offer further possibilities to provide the surgeon with even more effectiveness and safety, and, on the other hand, the patient with improvement of results.     

巨大垂体腺瘤的显微手术治疗

为提高巨大垂体腺瘤显微手术的疗效 ,回顾性分析 5 6例巨大垂体腺瘤患者的临床资料及治疗方法。依据肿瘤的生长方向及部位将 5 6例分为四型 ,据此分别采用经蝶、经额下、额下经蝶、扩大经蝶、扩大额下硬膜外、额下 -翼点等 10种入路进行显微手术。5 6例巨大垂体腺瘤全切 2 9例 ,近全切 2 0例 ,大部切除 7例。无死亡者。提示依据巨大垂体腺瘤的不同位置及生长方向选择适当的手术入路是提高全切率、降低死亡率及复发率的重要手段