老年人垂体腺瘤49例术后临床分析

目的 探讨老年人垂体腺瘤的临床特点和治疗效果。方法 回顾分析49例手术及病理证实的老年人垂体腺瘤资料。结果 49例患者平均病程4．4年。视力视野障碍46例（93．8％），头痛20例（40．8％），内分泌障碍16例（32．7％）。肿瘤大于3cm25例（51．0％），大部及部分切除11例（22．4％），以经碾人路效果为好。术后常规放疗28例，肿瘤控制率93．0％，其中50％发生垂体功能低下。随访7－127个月（平均50．5个月），视力改善27例（58．7％），生活理43例（87＝8％）；40例术后3个月－5年复查CT或MRI提示肿瘤消失30例（61．2％），残瘤静止5例（10．2％），复发5例（10．2％）。结论 老年人垂体腺瘤以大腺瘤和无功能腺瘤为多；临床以视力视野改变为主；经碟人路显微手术是首选治疗方法；术后辅以放疗可控制或延缓肿瘤复发，但需注意视力损害及垂体功能低下的严重并发症。

Clinical features and follow-up study of 49 elderly patients with pituitary adenomas

Objective To study the clinical features and therapeutic effects of pituitary adenomas in elderly patients. Methods The clinical materials including main clinical manifestations, diagnostic methods and outcome of treatments of 49 elderly patients with the pituitary adenomas from 1987 to1998 were analyzed retrospectively. Results It was showed from the data that the average duration of illness was 4 4 years; and 46(93 8%) cases were with visual deterioration, 20 (40 8%) with headache, and 16(32 7%) with endocrine abnormality. The diameter of tumors was more than 3 cm in 25 (51 0%), and the non functioning adenomas were found in 27 (55 1%). Operation was undergone through trans sphenoidal (61 2%), subfrontal (32 7%) and extensive subfrontal extradural approaches(6 1%), respectively. Among the 49 cases, tumor was totally or subtotally removed in 38 cases (77 6%), large partially or partially removed in 11 cases (22 4%). The results of operation through the trans sphenoidal approach were superior to other routes All patients were long term followed up for an average of 50 5 months. Visual disturbances were improved in 27 of 46(58 7%). A total of 43 patients could live by themselves Tumor disappearance was observed in 30 cases and recurrence in five cases. Five cases showed no changes in tumor size. 28 cases underwent radiotherapy after surgery and the occurrence rate of hypopituitarism after radiotherapy turned to be 50%. Total tumor control rate was calculated as 93%. Conclusions Macroadenomas and non functional pituitary adenomas happened most frequently in elderly patients and the main clinical symptoms was visual deterioration. Trans sphenoidal route for microsurgery was believed to be the first choice of operation. Tumor recurrence can be controlled or delayed by postoperative radiotherapy, but severe complication of the visual injury and pituitary dysfunction should be paid much attention.