垂体生长激素腺瘤经蝶入路手术预后因素分析

Analysis of factors influencing effect of transsphenoidal microsurgery for growth hormone-secreting pituitary adenoma

目的评价垂体生长激素腺瘤经蝶手术的疗效和分析影响手术疗效的相关因素。方法回顾性分析106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,根据肿瘤大小、术前生长激素水平、侵袭性等进行分类。随访术后激素水平、影像学检查评价手术疗效。结果垂体生长激素腺瘤患者进行经蝶手术后总缓解率为72.6%,Ⅰ级缓解率为84.2%,Ⅱ级为82.6%,Ⅲ级为64.7%,Ⅳ级为14.4%。Knosp 0、1、2、3、4级术后患者缓解率分别为89.7%、80.6%、66.7%、45.5%、0.0%。结论患者术前生长激素(growth hormone,GH)>30μg/L、肿瘤侵袭度>Ⅱ级是影响预后的危险因素;随肿瘤发展对患者颈内动脉包裹程度增加,术后缓解率显著下降。生长激素腺瘤患者缓解率和肿瘤大小、侵袭性、术前GH水平显著相关。

Objective To evaluate the therapeutic effect of transsphenoidal microsurgery for growth hormone-secreting pituitary adenoma（GHPA） and analyze the correlative factors influencing the effect. Methods The clinical data of 106 patients who underwent transsphenoidal microsurgery for GHPA were retrospectively analyzed.The tumors were classified according to tumor size,preoperative GH levels,and invasion etc.Based on the criterion of cure of acromegaly,postoperative hormone level and imaging examination were used to evaluate the post-operative outcomes. Results Total remission rate was 72.6%,and grades Ⅰ,Ⅱ,Ⅲ,and Ⅳ adenomas were 84.2%,82.6%,64.7%,and 14.4%,respectively.But according to Knosp grading,the remission rate of 0~4 grade were 89.7%,80.6%,66.7%,45.5% and 0.0%,respectively. Conclusion The prognoses were related to the size of the adenomas,the preoperative level of GH and invasiveness of GH-secreting adenomas.