经蝶手术治疗垂体生长激素腺瘤的长期随访

Long-term Following-up of Patients with Growth Hormone-secreting Adenomas after Transphenoidal Adenomectomy

目的评价垂体生长激素腺瘤经蝶手术的疗效,分析影响手术疗效的相关因素。方法回顾性分析162例资料完整经蝶手术治疗的垂体生长激素腺瘤病人的临床资料。根椐肿瘤大小、术前生长激素水平、侵袭性、肿瘤病理类型等进行分类,根据术后激素水平评价手术疗效。结果术后总缓解率为46.3%;微腺瘤、大微腺、巨腺瘤术后缓解率分别为76.1%、44.3%和13.5%;侵袭性和非侵袭性腺瘤的缓解率则为37.0%和58.6%。手术治疗效果与肿瘤大小、术前生长激素水平及肿瘤的侵袭性相关。结论微腺瘤和非侵袭性腺瘤采用经蝶手术可取得满意疗效,侵袭性腺瘤或巨大腺瘤采用经蝶手术治愈率较低,术后常需药物治疗或放疗。

Objective To explore the curative effect of transphenoidal adenomectomy on patients with growth hormone （GH）- secreting adenomas and the factors influencing their prognoses. Methods The clinical data of 162 patients with GH-secreting adenomas undergoing transphenoidal adenomectomy were analyzed retrospectively. The tumors were classified according to tumor size, preoperative GH levels, invasiveness and pathological type. According to the criterion of cure of GH-secreting adenomas, the postoperative hormone level was used to evaluate the curative effect. Results The rate of overall remission was 46.3% in these 162 patients. The rates of remission in the patients with microadenomas, large adenomas and huge ademomas were 76.1%, 44.3% and 13.5% respectively. The rates of remission in the patients with noninvasive adenomas and invasive adenomas were 58.6% and 17.1% respectively. The prognoses were related to the size of the adenomas, the level of GH and invasiveness of adenomas in the patients with GH-sereting adenomas. Conclusions The curative effects of transphenoidal adenomectomy on the patients with microadenomas and noninvasive adenomas are good, but its curative effects on the patients with huge adenomas and invasive adenomas, who should be radiotherapy after the surgery, are bad.