儿童及青少年垂体瘤的手术治疗(附42例临床分析)

Diagnosis and Treatment of Pediatric and Adolescent Pituitary Adenomas:A Report of 42 Cases

目的:探讨儿童及青少年垂体瘤的手术治疗。方法:回顾性分析2002年10月至2007年11月收治的42例儿童和青少年(平均年龄15.6岁)垂体瘤患儿的年龄和性别分布情况及发病特点、肿瘤分型、诊断与鉴别诊断和治疗与预后等情况。确诊主要依靠病理学,随访其内分泌学指标及MRI。结果:本组患儿男女比例为21:21,其中PRL腺瘤22例(22/42例,52.4%),无功能腺瘤7例(7/42例,16.7%),GH腺瘤5例(5/42例,11.9%),多激素腺瘤2例(2/42例,4.8%),TSH腺瘤2例(2/42例,4.8%),ACTH腺瘤4例(4/42例,9.5%)。微腺瘤与大腺瘤之比为19:23(1:1.21),侵袭性大腺瘤8例(男女之比为6:2)。经鼻蝶手术治疗35例(35/42例,83.3%),经眶锁孔手术3例(3/42例,7.2%),经额下2例(2/42例,4.8%)及经翼点2例(2/42例,4.8%)。治愈率为64.3%(27/42例),控制率为21.4%(9/42例),改善率为11.9%(5/42例),未愈为2.4%(1/42例)。结论:儿童期垂体瘤少见,女性患儿中PRL型腺瘤是最常见的亚型。应根据不同类型采取个性化治疗方案,大部分患儿采用经鼻蝶手术是有效并且安全的治疗方式。

Aim： To investigate the clinical features of pediatric and adolescent pituitary adenomas. Methods： Between Oct. 2002 and Nov. 2007, 42 patients（〈18 year-old）diagnosed as pituitary adenomas in Huashan Hospital were treated. The clinical data were retrospectively analyzed. Diagnosis was ensured by the pathological examination, the endocrinological levels and MRI were analyzed by the follow-up survey. Results： The ratio of male to female was 21：2 1. There were 22 cases PRL-secreting adenomas（22/42, 52.4%）, 7 cases non-functioning adenomas（7/42, 16.7%）, 5 cases GH-secreting adenomas（5/42, 11.9%）, 2 cases plurihorminal adenomas（2/42, 4.8%）, 2 cases TSH-secreting adenomas（2/42, 4.8%）, 4 cases ACTH-secreting adenomas（4/42, 9.5%）. The ratio of micro-adenoma versus macro-adenoma was 19：23（1：1.21） and there were 8 cases invasive macro-adenoma （male to female 6：2）. Transsphenoidal surgery was applied in 35 cases （35/ 42, 83.3%）, with respect to 3 cases（3/42, 7.2%） in transorbital keyhole approach, 2 cases （2/42, 4.8%） through pterional approach, still 2 cases（2/42, 4.8%） through transsubfrontal approach. The curative rate is 64.3%, control rate is 21.4%, improvement rate is 11.9%, and 2.4% of the cases was not cured. Conclusion： Pituitary adenomas are rarely present during childhood though the incidence increases during adolescences. Transsphenoidal surgery is an effective and secure method for most patients.