肢端肥大症合并糖尿病或糖耐量减退经蝶窦手术的疗效

Acromegaly with diabetes mellitus or glucose intolerance: influence of transsphenoidal pituitary adenomas microsurgery for 77 cases

目的总结经蝶窦垂体生长激素(GH)腺瘤切除术对肢端肥大症合并继发性糖尿病或糖耐量减退病人的疗效。方法回顾性分析77例采用经单鼻孔或口鼻蝶改良入路显微手术切除肿瘤治疗该类病人的临床资料。结果肿瘤全切除加次全切除率85.7%;内分泌治愈加缓解56例(72.7%);血糖达到糖尿病一般控制以上标准者67例(87.0%);术后死亡1例。结论经蝶窦手术切除肿瘤能够纠正肿瘤高GH分泌状态,可在术后1周左右使继发性糖尿病及糖耐量减退得到控制。应注意对病人的心功能进行评估与保护。

Objective To analyze the curative effect of transsphenoidal surgery for acromegaly with secondary diabetes mellitus (DM) and glucose intolerance (IGT). Methods 77 cases of acromegaly with DM and IGT were reviewed. Results The operative approach includes transnasal approach and sublabial approach. The rate of total excision and subtotal excision is 85.7%. The rate of cure and remission in endocrinology is 72.7% (56 cases), the control rate is 87.0% (67 cases), and the mortality is 1.3% (1 case). Conclusion While the high GH secretion was reduced by transsphenoidal pituitary adenomas microsurgery in acromegaly with DM or IGT, the hyperglycemia was relieved one week after operation. Moreover, the evaluation and protection of cardiovascular function is very important.