垂体生长激素腺瘤的诊断和治疗95例分析

The Diagnosis and Treatment of Growth Hormone Secreting Pituitary Adenomas: Analysis of 95 Cases

背景与目的:生长激素腺瘤的诊断和治疗方法不一,疗效一直不尽如人意。本文回顾性总结和分析垂体生长激素腺瘤的临床诊疗经验,探讨现代诊断标准的制定意义和治疗方案的可行性。方法:2004年6月至2005年12月收治垂体生长激素腺瘤病例共95例,其中Ⅰ级29例,Ⅱ级36例,Ⅲ级30例,侵袭性腺瘤11 例。除1例接受额下入路手术外,其余94例均接受经鼻蝶手术治疗,其中单纯手术(手术组)62例,术前结合生长抑素类药物治疗(手术+药物组)33例。采用目前国际标准方法来评估治疗效果及其预后。结果:全部病例中,手术全切除81例(85.3%),次全切除14例(14.7%),其中11例侵袭性腺瘤均为次全切除。IGF-1恢复至与性别和年龄组相匹配正常范围者64例(67.4%)。除外侵袭性腺瘤,手术组全切除率为94.7%,IGF-1恢复正常者39例(68.4%),手术+药物治疗组的全切除率为100%,IGF-1恢复正常25例(92.6%)。结论:经鼻蝶手术是目前治疗垂体生长激素腺瘤的首选方法,术前应用生长抑素类药物可以缓解术前高血糖、心肺功能不全等症状,提高手术安全性。术前用药可以明显改善术后IGF-1的水平,正常的IGF-1水平预示患者生存时间接近正常人群。制定和实施国际统一的生长激素腺瘤诊断标准对于疗效评估、术后随访治疗和预后判断具有重要的指导意义。

BACKGROUND ＆ OBJECTIVE： Growth hormone （GH） secreting adenoma is a common pituitary tumor. This study was to find out the significance of the modern diagnostic criterion and the feasibility of different treatment strategies. METHODS： From June 2004 to December 2005, ninety-five cases with GH pituitary adenomas we treated in our institution. Among them, 29 cases were type Ⅰ,36 were type Ⅱ,30 were typeⅢ, and 11 cases were invasive adenomas. Except one case treated by subfrontal approach, the other 94 were treated through endonasal transsphenoidal approach. Among them, 62 cases were treated with operation alone. Thirty-three cases were treated with operation and drug administration （preoperative somatostatin treatment）. The therapeutic effect and Prognosis Were Evaluated By The Modern International Criterion. RESULTS： Among all the cases, 81 adenomas （85.3%） were totally removed, 14 adenomas （14.7%）were subtotally removed. Moreover, all the eleven invasive adenomas were subtotally removed. The IGF-1 levels in 64 cases （67.4%） became normal according to sex and age. Except the invasive adenomas, the total removal rate was 94.7%, and the level of IGF-1 became normal in 92.6% （25 cases）. CONCLUSIONS： The transnasal-sphenoidal approach is the primary method to the GH pituitary adenoma. And the preoperative somatostatin treatment can remiss the preoperative symptoms, such as hyperglycaemia, cardiac and pulmonary dysfunction, and improved the operation safety. The preoperative drug can ameliorate the postoperative IGF-1 index. The normal IGF-1 level predicted the survival period of the patients would be close to the normal ones. The formulation and practice the international unified diagnostic criterion of GH pituitary adenomas have great instructive significance to the therapeutic effect evaluation, postoperative follow-up and prognosis determination.