功能性垂体腺瘤经蝶窦术后的随访研究

目的:探讨经蝶入路手术治疗泌乳素(PRL)腺瘤、生长激素(GH)腺瘤和促肾上腺皮质激素(ACTH)腺瘤的效果及手术前后血清内分泌学变化.方法:我科1995年10月至2002年9月用显微外科手术治疗垂体腺瘤254例,其中具有完整血清内分泌学检查结果和MRI随访资料的功能性垂体腺瘤143例,其中PRL腺瘤61例,GH腺瘤50例,ACTH腺瘤32例.平均随访时间为2.3年.结果:GH腺瘤和ACTH腺瘤的全切率明显高于PRL腺瘤(P<0.01),GH腺瘤与ACTH腺瘤相差不显著(P>0.05).肿瘤的全切率与肿瘤的大小相关(P<0.05),微腺瘤全切率高于大腺瘤.肿瘤全切率与肿瘤侵袭性明显相关(P<0.05).PRL腺瘤的复发率明显高于GH腺瘤和ACTH腺瘤(P<0.05).侵袭性垂体腺瘤的复发率高于非侵袭性垂体腺瘤(P<0.05).术后血清内分泌水平均全面降低.结论:GH腺瘤与ACTH腺瘤的治疗效果优于PRL腺瘤.功能性垂体腺瘤的治疗效果与肿瘤的内分泌特征和侵袭性有关.

Follow-up of transsphenoidal surgery for secreting pituitary adenomas

Objective:To study the effectiveness of transsphenoidal surgery for GH ,ACTH ,and PRL secreting pituitary adenomas.Methods:Among 254 patients with diagnosed pituitary adenomas from Oct.1995 to Sep.2002,143 cases of secreting pituitary adenomas(56.3%) had the full endocrinological testing and MRI follow up information (61 PRL ,50 GH ,32 ACTH ).The median follow up time was 2.3 years.Results:The total removal rate for PRL secreting adenomas (34.4%) was significantly lower than that for GH (68.0%) and ACTH secreting (78.1%) adenomas( P <0.01).Total removal rate was correlated with tumor size and invasiveness:that of microadenomas was higher than macroadenomas( P <0.05) and that of noninvasive adenomas was higher than invasive adenomas( P <0.05).The recurrence rate of PRL secreting adenomas was higher than that of ACTH and GH secreting adenomas ( P <0.05); that of invasive adenomas was higher than noninvasive adenomas( P <0.05).Hormonal level in secreting pituitary adenomas had an overall decrease postoperatively.Conclusion:The therapeutic effects of GH and ACTH secreting pituitary adenomas are better than that of PRL secreting adenomas.The therapeutic effects of secreting pituitary adenomas are related to their endocrinological feature and invasiveness.