垂体腺瘤经蝶窦显微手术444例临床及病理研究

A clinical and morphological study of 444 patients with pituitary adenomas via transsphenoidal approach

目的 :旨在研究垂体瘤临床某些特征及常规病理和超微结构改变。 方法 :回顾性研究自 1982年 7月～ 1996年 10月间 4 4 4例经窦蝶手术治疗垂体腺瘤的临床特点 ,其中 119例术中鞍底硬膜取检。光镜检查 4 2 4例 ,免疫组化检查 2 9例 ,电镜检查 10 3例 ,将临床结合病理进行了分析研究。 结果 :发现鞍区非泌乳素垂体腺瘤同样可以产生高泌乳素血症 ;鞍底硬膜有瘤细胞侵犯 78例 (6 5.5% )。 结论 :(1)高泌乳素 (PRL )血症并非泌乳素腺瘤所特有 ,在诊断中应注意鉴别 ;(2 )鞍底硬膜受肿瘤侵犯是垂体腺瘤侵袭邻近组织的一个重要标志 ,与无硬膜侵犯者相比 ,治疗效果有显著差异 ,并和预后密切相关 ;(3)根据病情选择合适的疗法 。

Objectives: To study some of the clinical and morphological features of pituitary adenomas. Methods: The clinical features of 444 cases of pituitary adenomas treated by transsphenoidal microsurgery between July 1982 and October 1996 was studied retrospectively. Pathological examination of dural specimens of sellar foot was performed in 119 cases. Routine histological examination was performed in 424, immunohistochemical examination in 29, and electron microscopic examination in 103 cases. Results:Apart from polactinomas, hyperprolactinemia wasalso found in many cases of so called nonfunctioning adenomas. Dura mater was invaded by tumors in 78 cases( the incidence of dural invasion was 65.5 %). Conclusions:Hyperprolactinemia was not peculiar to prolactinomas, thus a differential diagnosis was necessary when hyperprolactinemia existed.Invasion of dura mater of sellar floor was an important hallmark of adjacent tissues invasion by pituitary adenomas.The outcome of surgical treatment was significantly different between patients with dural invasion and without.