MANAGEMENT OF EXTRA-SELLAR PITUITARY TUMOURS WITH BROMOCRIPTINE: COMPARISON OF PROLACTIN SECRETING AND NON-FUNCTIONING TUMOURS USING HALF-FIELD VISUAL EVOKED POTENTIALS AND COMPUTERISED TOMOGRAPHY

To determine whether prolactin secreting and non-functioning pituitary tumours respond differently in terms of shrinkage to bromocriptine, we prospectively studied ten consecutive patients (five with prolactinomas and five with non-functioning tumours) complicated by extra-sellar extensions. No patient had received prior radiotherapy or bromocriptine and the mean dose and duration of bromocriptine treatment were identical in the two groups of patients. Objective evidence of tumour shrinkage was provided by serial half-field visual evoked potentials (VEPs) and computerised tomography (CT). All five prolactinomas were shown to shrink as assessed by improvement in VEP and four of the five as assessed by CT. In contrast, only one of the five patients with nonfunctioning tumours showed any improvement in VEP or CT. Macroprolactinomas frequently shrink rapidly when treated with bromocriptine, whereas non-functioning tumours seldom show such a dramatic response.     

平扫CT值在常见肾上腺肿瘤鉴别诊断中的应用价值

目的:评价平扫CT值在肾上腺常见肿瘤诊断中的应用价值,并结合肿瘤大小优化选择肾上腺腺瘤与非腺瘤的鉴别阈值。方法:回顾性分析经手术及病理证实的肾上腺肿瘤209例(221个病灶),其中腺瘤137个,非腺瘤84个,分别测量肿瘤的大小及平扫CT值并计算不同CT值阚值鉴别腺瘤与非腺瘤的敏感度、特异度、准确度、阳性预测值及阴性预测值。结果:137个腺瘤平扫CT值-12～59(13.19±12.84)HU,直径0.3～7.3cm,其中包括88个无功能性腺瘤,平扫CT值-12～59(15.04±13.01)HU;醛固酮腺瘤43个,平扫CT值-8～42(10.19±12.26)HU;皮质醇腺瘤6个,平扫CT值-4.6～18(7.58±10.16)HU。84个非腺瘤平扫CT值15～69(38.33±10.08)HU,直径1.5～11.6cm,包括:嗜铬细胞瘤43个,平扫CT值15～69(38.67±11.05)HU;节细胞神经瘤5个,平扫CT值18～39(29.60±8.65)HU;皮质癌28个,平扫CT值26～58(38.96±8.84)HU;转移癌8个,平扫CT值28～54(39.75±8.24)HU;腺瘤和非腺瘤的平均平扫CT值差异有显著性意义(t=-15.281,P=0.000)。使用CT值25HU且肿瘤大小≤4cm作为鉴别腺瘤与非腺瘤的阈值时诊断腺瘤的敏感度73.7%,特异度100%,准确度83.7%,阳性预测值100%,阴性预测值70%。结论:平扫CT值在肾上腺腺瘤与非腺瘤的鉴别诊断上有重要价值,以平扫CT值≤25且肿瘤大小≤4cm作为腺瘤的诊断标准是比较合适的,特异度高,敏感度及准确度均较高。但在进一步鉴别腺瘤及非腺瘤的组织类型及具体临床诊断中的作用有限,需结合临床其他检测手段及病理结果做出全面准确的判断。     

全神经内镜下经鼻蝶入路手术治疗垂体腺瘤72例临床分析

目的 探讨和评价全神经内镜下经鼻蝶入路切除垂体瘤的手术技巧及临床应用价值.方法 2009年1月至2012年3月,完成72例单纯神经内镜经鼻-蝶垂体瘤切除术,回顾性分析患者术前、术后症状及激素水平变化、影像学资料、手术资料、并发症、随访资料等. 结果 72例病例中非功能性腺瘤22例(30.6％),泌乳素腺瘤24例(33.3％),生长激素腺瘤7例(9.7％),促肾上腺皮质激素腺瘤5例(6.9％),促甲状腺激素腺瘤1例(1.4％),多分泌性腺瘤13例(18.1％);肿瘤全切除56例(77.8％),次全切除13例(18.0％),部分切除3例(4.2％);并发脑脊液漏5例,出现短暂性尿崩6例.术后随访3 ～ 24个月,大部分功能性腺瘤术后激素基本恢复正常水平,术后1例视力变差,其余患者症状亦基本恢复正常. 结论 全神经内镜经鼻蝶手术切除垂体腺瘤是一项安全、微创、有效的方法,具有全程直视下切除肿瘤的优点,但系统、专业的训练及相应的设备是必不可少的.     

肝细胞腺瘤和肝腺瘤病11例诊治分析

目的 探讨肝细胞腺瘤(hepatocellular adenoma,HCA)及肝腺瘤病(liver adenomatosis,LA)的临床表现、治疗方法和预后.方法 回顾性分析经手术治疗的10例HCA及1例LA患者的临床资料.结果 本组女性发病居多,共7例(63.6％),1例女性肝腺瘤病患者有口服避孕药病史.全组中位发病年龄33(范围25～70)岁.多数无临床症状(72.7％).肿瘤标记物CA19-9和甲胎蛋白(AFP)正常.超声造影、CT及磁共振(MRI)增强扫描多提示病灶动脉期强化,门脉期、延迟期去强化.组织病理提示10例为单发病灶,诊断HCA,其中1例肿瘤细胞轻度异型及不典型增生,1例存在细胞不典型增生,1例细胞生长活跃;另外1例为多发病灶,细胞存在异型,诊断肝腺瘤病.11例患者均经手术切除,经随访21～125个月,无复发.结论 HCA患者多无明显临床表现,肝脂肪变性可能为HCA和LA的共同病因,口服避孕药物可能为LA的病因.动态影像学检查有助于诊断,HCA有病灶破裂出血及癌变危险,首选手术治疗,预后良好.     

胰腺浆液性微囊性腺瘤临床病理分析

目的 探讨胰腺浆液性微囊性腺瘤的临床病理特征及其诊断与鉴别诊断.方法 对7例胰腺浆液性微囊性腺瘤病例的临床资料、病理形态、免疫组化进行分析.结果 7例患者均为女性,平均年龄51岁,有临床症状者2例(28.6％).镜下肿瘤主要由大小不等的囊腔组成,囊壁衬覆单层立方上皮,细胞胞质透明并富含糖原.上皮细胞核小而圆,居中,无核仁,无核分裂象.部分囊腔之间可见粗大的纤维组织分隔.免疫组化上皮细胞AE1/AE3、CK7、CK8、CK19、CK/LMW、EMA(+);CEA、CD31、CD34、D2-40、Syn、CgA、Calretinin、Vim(一).结论 胰腺浆液性微囊性腺瘤是一种较为少见的良性肿瘤,老年女性好发,预后好,确诊主要靠术后病理组织学和免疫组化.     

Suprapubic prostatectomy with a novel catheter

PURPOSE: We evaluated the postoperative morbidity and technical complications of a new handmade catheter used for suprapubic prostatectomy. MATERIALS AND METHODS: A total of 146 patients with lower urinary tract symptoms who had indications for open prostatectomy were enrolled in the study from January 2003 to August 2004. Of the patients 96 were treated with a novel technique without a urethral catheter but with a special handmade cystostomy catheter, while the other 50 underwent the traditional procedure using cystostomy and a urethral catheter. The same surgical team operated on the 2 groups. Clot retention episodes, hemoglobin decreases, irritative symptoms, voiding status after cystostomy removal and incontinence were evaluated postoperatively. Three months later we followed the patients with symptom score, maximum flow rate and cystoscopic examination. RESULTS: Preoperatively mean International Prostate Symptom Score was 31.6 in each group. Postoperatively none of the patients with the novel catheter complained of significant irritative urinary symptoms, clot retention and true or stress urinary incontinence. Of the cohorts 94% were satisfied with voiding but 86% of controls were satisfied. There was no report of urinary tract infection or epididymo-orchitis in the cohorts, while we found epididymo-orchitis in 4 controls (8%). Three months after the operation the mean International Prostate Symptom Score was 4.4 (range 1 to 7) and the mean maximum flow rate was 22.6 ml per second (range 14 to 25) in patients with the novel catheter, and 4.2 (range 1 to 7) and 22.5 ml per second (range 15 to 25), respectively, in those with the traditional catheter. At followup there was no bladder neck contracture but 4 patients (4.1%) showed some degree of membranous urethral stricture. We also noted 7 controls (14%) with urethral stricture. CONCLUSIONS: Transurethral prostate resection has been introduced as the surgical treatment of choice in patients with benign prostatic hyperplasia. However, open adenomectomy still has a place. Urethral catheter-free suprapubic prostatectomy can be safely applied with a low postoperative risk of infection, incontinence and stricture formation.     

磁共振化学位移成像对肾上腺肿瘤的诊断（附18例报告）

目的：评价磁共振（magnetic resonance,MR）化学位移成像（chemical shift imaging,CSI）对肾上腺腺瘤的诊断价值。方法：回顾分析我院18例肾上腺肿瘤患者,术前均进行了MR-CSI检查,对其病历资料及MR图象进行分析。结果：12例肾上腺腺瘤在MR—CSI同相位、反相位序列的检查中,均表现为反相位不同程度的信号减低,6例非腺瘤性病变反相位上不表现为明显的信号降低。结论：MR—CSI对肾上腺腺瘤与非腺瘤性病变的诊断与鉴别诊断具有重要价值。     

不同促性腺激素释放激素类似物对垂体反应性的作用

促性腺激素释放激素类似物分为激动剂与拮抗剂,在辅助生殖治疗中,主要用于抑制黄体生成素(LH)峰,预防卵泡早排,但两者对垂体反应性产生不同的作用。本文旨在讨论不同促性腺激素释放激素类似物对垂体反应性的影响,以及垂体外效应。     

垂体降调节后促性腺激素启动时机的选择

体外受精-胚胎移植(IVF-ET)治疗过程中,传统的降调节方案已演化为各种各样的个体化促性腺激素释放激素激动剂(GnRH-a)降调节。其目的是垂体被抑制得恰到好处,具有合适的LH水平和E2水平,同时窦卵泡的大小均匀,此时启动促性腺激素(Gn),卵泡对外源性Gn敏感性好,错开了卵泡无反应平台期的刺激时间和剂量,降低Gn用药剂量及用药时间,从而减轻患者的经济负担和精神压力,可以获得良好的临床结局。常用的降调节标准是Gn启动前血清E2≤50pg/m1(183pmol/L),LH5U/L,卵泡直径5~10mm及子宫内膜厚度≤5mm。     

后肾腺瘤的临床特征(附1例报告及文献复习)

目的 探讨后肾腺瘤的临床表现及影像学、病理学特征,提高对后肾腺瘤的认识和术前诊断水平.方法 回顾性分析1例后肾腺瘤患者的相关资料并进行相关文献复习.结果 患者术后病理诊断为后肾腺瘤;术后恢复较好,顺利出院.结论 后肾腺瘤的临床特征有限,多为体检时发现,术前需结合生化及影像学检查综合判断,必要时行穿刺病理及术中冷冻病理明确诊断,为患者选择合适手术方式;一般预后良好,但术后仍需定期复查.