垂体瘤卒中诊断和治疗的再探讨

Reconsideration for Diagnosis and Treatment of Pituitary Apoplexy

目的探讨典型和不典型垂体瘤卒中的发病机制,从而为合理制定治疗方案和正确选择手术时机提供帮助。方法经临床表现和/或手术治疗及病理学诊断为垂体瘤卒中病例28例中,24例符合垂体瘤卒中的典型临床表现,另4例符合不典型垂体瘤卒中的诊断。分析垂体瘤卒中的临床表现、影像学表现、手术及病理发现与病程之间的关系及其在病程中各时期的影像学表现、手术发现及病理诊断的特征。结果根据典型垂体瘤卒中病程中不同阶段的临床症状体征、影像学、手术及病理特点,将病程分为早期梗死出血期和后期坏死期,手术全切率分别为87.5%(7/8)和100%(14/14)。不典型垂体瘤卒中的影像学、手术和病理均证实为瘤内陈旧性出血,手术全切率为75.0%(3/4)。结论典型垂体瘤卒中多因肿瘤梗塞后坏死并继发出血所致,急诊手术治疗目的是为了缓解症状。后期坏死期的手术效果明显优于早期梗死出血期,症状不显著者可采用激素替代保守治疗。不典型垂体瘤卒中以慢性瘤内出血为主要特征,无急诊手术治疗指征。

Objective To explore the pathogenesis of typical and atypical pituitary apoplexy in order to help to formulate the reasonable treatment program and to select correct operative time. Methods Of 28 patients with pituitary apoplexy diagnosed by the clinical manifestation, pathological examination and/or the intraoperative findings, 24 suffered from typical pituitary apoplexy and 4 from atypical pituitary apoplexy. The relationship of the course of disease with clinical manifestation, imaging manifestation, and intraoperative and pathological findings, and their characters during all the periods were analyzed, Results According to clinical and imaging manifestations, the findings in the operation and pathological features, the course of the typical pituitary apoplexy could be divided into two stages, i,e, the early stage （hemorrhagic infarct） and the late stage （necrosis）, The rate of total removal of the pituitary tumors in the early and late stage was 87,5%（7/8） and 100%（14/14） respectively, The old intratumorous hemorrhage in the atypical pituitary apoplexy, in which the rate of total removal of the tumours was 75,0%（3/4）, was proved by imaging, intraoperative finding and pathological examination, Conclusions Typical pituitary apoplexy was caused mainly by the hemorrhage secondary to the necrosis after the infarct, The purpose of emergency operation is for the relief of severe symptoms, The operative effect on the typical pituitary apoplexy in the late stage was significantly better than that in the early stage, The patients without significant symptoms can be conservatively treated by hormone substitution therapy, The atypical pituitary apoplexy was characterized by the chronic intratumorous bleeding and has no indication of emergency operation,