200例垂体GH腺瘤经蝶手术疗效观察

Transsphenoidal Microsurgical Removal of GH-secreting Pituitary Adnomain:A Report of 200 Cases

１９７９年７月～１９９２年３月共施行经蝶显微外科切除垂体ＧＨ腺瘤２１２例，其中２００例有术前后ＧＨ测定对比，大腺瘤１３２例，微腺瘤６８例。１９８６年后的１３８例在手术方法上进行了改进。本组总治愈缓解率为７２．５％，其中大腺瘤的治疗缓解率从１９８６年前的３１．４％提高到６９．１％；微腺瘤从４４．４％提高到８０．５％。１例手术中出现心脏意外死亡，死亡率为０．５％。ＧＨ水平动态观察结果显示，术后２周内ＧＨ水平与以后的ＧＨ水平基本一致，故认为术后２周ＧＨ水平可作为判断手术疗效的主要指标。本文对影响疗效的诸因素及术后常见并发症的防治进行了讨论。

From July 1979 to April 1992 ,212 cases of GH-secreting pituitary adenoma were treated transsphenoidally by microsurgical technique,of whom two hundred cases monitored with their GH levels at preoperative and postoperative periods.The majority of cases totally 132 cases were of macroadenoma,and 68 cases were of microadenoma.138 cases were operated on after April 196.The cure and remission rate averaged to 72.5%, rising from 44.4%(before 1986)to 80.5%for microadenoma and from 31.4%to 69.1%for macroadenoma due to improvement of technique and accumulation of experience. One patient died of angiocardiopathy suddenly during operation. Mortality rate was 0.5%。 The follow-up observation of postoperative GH levels in 52 cases revealed that the GH levels within 2 weeks after operation were the same as in 3～6months. It is thought that the early GH levels may represent the surgical results.The surgical technique is described and factors influencing the surgical results, prevention and treatment of operative complications are discussed in this paper.