经蝶窦显微外科切除垂体生长激素腺瘤(104例疗效分析)

报告104例经蝶窦显微外科切除垂体生长激素腺瘤。1986年6月前的57例中,微腺瘤的治愈缓解率为46.2%,大腺瘤为35.5%。以后的47例由于手术技术的提高和经验的积累,微腺瘤和大腺瘤的治愈缓解率分别为70%和64.8%。本文对影响疗效诸因素及手术并发症的防治进行讨论。     

PITUITARY ADENOMAS WITH ACROMEGALY LIGHT MICROSCOPIC AND ELECTRON MICROSCOPIC STUDY OF 60 CASES

Analysis of 60 pituitary adenomas with acro- megaly iiS made. All 60 surgical specimens are studied by both light and electron microscopy. By light microscopy we classified the adenomas into strong acidophilic cell (16 cases) and weak acidophilic cell (20 cases), stem cell (2 cases) and mixed cell type adenomas (22 cases). By electron micros.copy we classified them into densely granulated (14 cases) and sparsely granu- lated growth hormone (GH) cell adenomas (212 cases) in which there are fibrous bodies near the indented part of the nucleus which are of diagnostic value, corresponding to the round lucent area near the indented nucleus seen by light microscopy. The densely granulated and sparsely granulated GH cells may coexist within 1 adenoma (4 cases). Some adenomas may con- tain 2-3 kinds of secretory granules and are called multiple functional adenomas, in this series 18 had GH-;-PRL prolactin), 1 GH+ACTH and l GH+PRL+ACTH. Strong acidophilic cells correspond to densely granulated GH cells while weak acidophilic celIs correspond to sparsely granulated GH cells. The number of strong or weak acidophilic cells and number of secretory granules are not directly proportional to the GH blood level. By electron microscopy GH, PRL and ACTH secretory granules have characteristic features which are not absolute. Correct diagnosis is based upon combining the clinical symptoms and signs, blood hormone levels and secretory granule morphology. F'ibrous body diagnostic value and their genesis and development are dis- cussed.     

颅内脂肪瘤2例报告

颅内脂肪瘤约占颅内肿瘤的0.34～0.46％。过去的病例多在尸检中偶被发现。自CT应用后,因颅内脂肪瘤的好发部位及其特征性的CT表现,多数病例生前可确诊。本文报导1例胼胝体脂肪瘤及1例罕见的鞍区脂肪瘤。     

HYPERPROLACTINEMIA ITS RELATION TO GALACTORRHEA, AMENORRHEA, PITUITARY TUMOR AND ITS MANAGEMENT

Hypperprolactinemia and its relation to galactorrhea, amenorrhea and pituitary tumor were studied in 355 cases. Hyperprolactinemia was found in 135 cases, and its incidences in the 3 groups (galactorrhea with amenorrhea, galactorrhea with menstruation and amenorrhea without galactorrhea) were 78.2u/o (111/ 142), 21.7% (18/83) and 4.6:vo(6/130) respectively, the differences being statistically significant (p<0.01). Of the hyperprolactinemia cases 9570 had galactor- thea, and about half of them were discovered during examination. Therefore, pressing the breasts for milk should be a routine procedure during gyno cologic examination. There were 60 pituitary ma croadenomas in this series; the incidence of hyperprolactinemia was 39.3To (53/153) and amenor thea with galactorrhea was 37.3%(53/'142). There fore, prolactinoma is the most important cause of galactorrhea, amenorrhea and hyperprolactinemia. Some prolactinomas may not be accompanied by amenorrhea, galactorrhea or hyperprolactinemia. 42 cases of hyperprolactinemia, half with pituitary tumors, were treated with bromocriptine. Menstrua tion resumed in 95.2%, biphasic basal body tempera. ture (BBT) in 90.5%, and 70.6To infertile patients became pregnant. The present study shows that the important cause of amenorrhea is functional dis turbance in the hypothalamic-pituitary-ovarian axis. Once prolactin level is lowered, functional distur- bances can be corrected very quickly.     

经蝶窦选择性切除垂体ACTH腺瘤治疗柯兴氏病

用本法治疗11例柯兴氏病患者,8例摘除成功,3例手术失败,无1例死亡;8例切除标本中7例经电镜证实为垂体ACTH分泌腺瘤;7例缓解,其症状明显改善或消失,24小时UFC恢复正常,1例缓解不全。文中讨论了此病的诊断、手术指征及手术禁忌证。     

DIAGNOSIS AND SURGICALTREATMENT OF CONGELNITALANOMALl[ES OF THEATLANTO-OCCIPITAL REGION

73 cases of congenital anomalies of the atlanto-occipital region are diagnosed and treat- ed operatively. Clinical appearance, symptoms and signs of cranial nerves, upper cervica.l cord and cerebellum, radiologic findings and opera- tive technic a.re presented. Long term surgical results are Gra.de I 39 cases, Grade 11 12 cases, Grade 111 4 cases and Grade IV 3 cases. Dif- ferential diagnosis, time of s;urgery and opera- tive complications are discussed.     

甲状腺低功所致垂体促甲状腺素、催乳素混合腺瘤(1例报告及文献复习)

甲状腺低功所致垂体促甲状腺素、催乳素混合腺癌很罕见。本例的临床及实验室主要特征为:甲状腺低功,闭经,溢乳,视力左0.1,右0.3,双颞侧偏盲,血清T_4、T_3U值下降及PRL升高,甲状腺微粒抗体增加,TRH对TSH刺激试验呈过强反应。术后肿瘤超微结构检查发现瘤细胞内有TSH、PRL分泌颗粒及微小管。术后视功能迅速恢复,1个半月后月经来潮,溢乳停止,血TSH、PRL接近正常。     

经额开颅及经鼻显微手术治疗垂体腺瘤的比较

自1958年到1983年,共手术治疗垂体腺瘤262例,其中经开颅手术切除肿瘤150例,经鼻显微手术112例。近5年开展经鼻垂体显微手术后,平均每年收治病人较前20年增加6.7倍。垂体内分泌激素的各种测定检查,是垂体肿瘤早期诊断的重要手段,可使病人的确诊和治疗大为提前。经鼻显微手术对鞍内垂体微腺瘤的85％可作到全部或次全切除(53％及32％),从而减少了术后放疗和复发率,提高了垂体内分泌功能恢复的水平。     

脑垂体微腺瘤经蝶窦显微外科治疗（120例临床分析）

本文报告经蝶窦显微外科治疗脑垂体微腺瘤120例,其中男20例,女100例,平均年龄31.7岁。视力视野正常,蝶窦大小都正常范围之内,垂体内分泌素测定皆高于正常。CT 扫描有不正常发现者65.4%,阴性者34.6%。肿瘤大小皆在10mm 之内。治愈率包括早年病例为46.6%,近3年已提高到81.2%,其中 ACTH 治愈率较高、GH 其次、PRL 较差,对脑垂体微腺瘤的诊断和疗效问题也加以讨论。     

22例蝶骨嵴脑膜瘤手术治疗体会

报告２２例蝶骨嵴脑膜瘤手术治疗资料。根据ＣＴ和术中所见，Ｂｏｎｎａｌ氏分类，Ａ组（内１／３）１２例，Ｄ和Ｅ组冲、外１／３）各５例。Ｄ和Ｅ组全切除率为１００％，Ａ组为４１．６％。肿瘤切除程度与其类型、大小有密切关系。强调早期诊断和手术切除以提高全切除率，减少复发。术前供血动脉栓塞，术中应用显微外科技术，ＣＵＳＡ和双极电凝等有利于肿瘤全切并减少对周围重要结构的损伤。本文就手术技巧，尤其是内１／３肿瘤的切除技术进行了较详细的讨论。