经蝶窦入路手术治疗垂体生长激素腺瘤

Transsphenoid surgery of pituitary adenoma of growth hormone

目的探讨垂体生长激素(GH)腺瘤患者的肿瘤大小、术前GH水平、术中GH的动态变化对手术效果的影响。方法回顾分析47例垂体GH腺瘤,18例术前行口服糖耐量试验(OGTT);均采用经蝶窦入路手术,19例术中检测GH水平,21例术后1个月行OGTT试验。结果术后随访期内临床症状明显缓解的30例,随访期内GH<2.0 ng/ml的有29例,总的缓解率61.7%,其中微腺瘤77.7%、大腺瘤的缓解率是51.7%。结论垂体GH腺瘤患者的早期诊断是提高手术效果的关键,OGTT抑制试验有助于早期诊断;经鼻蝶入路手术是治疗首选,术中GH的动态观察有助于早期判断手术效果,若能及时快速测定GH,将有助于提高缓解率。

Objective To explore the effect of tumor size, preoperative GH and the intraoperative growth hormone （GH） measurement on the operative outcome in pituitary adenoma of GH. Methods The clinical data of 47 patients with aeromegaly wereanalyzed retrospectively . The oral glucose tolerance test was used in pre-operative diagnosis and post-operative evaluation. All the patients were operated through transsphenoid and the intraoperative GH was measured in 19 patients. Results After the operation, the symptoms of acromegaly were significantly relieved in 30patients. According to the criteria of remission, there were 29 （61.7%）. However, the remission rate of microadenoma （77.7%） was significantly higher than that in macroadenoma （51.7%）. Conclusion The early diagnosis of acromegaly is the crucial of the improvement of surgical outcome. For the doubt cases,OGTT is helpful for the early diagnosis. The transsphenoid approach is the first choice of the treatment of acromegaly. The intraoperative GH measurement is valuable for the early evaluation of surgical outcome. If the intraoperative GH can be rapidly and timely measured, it will be effective to increase the remission rate.