老年人垂体瘤的诊断和治疗

Diagnosis and treatment of pituitary adenomas in elderly patients

目的 分析总结老年人垂体瘤的临床、诊断和治疗特点。方法 回顾分析８０例老年人垂体瘤的资料。结果 平均病程３．６年。视力视野障碍６６例（８２．５％），内分泌紊乱３６例，头痛３３例，合并其他疾病５６例（７０％）。ＣＴ或ＭＲＩ发现大腺瘤７８例（９７．５％）。手术采用经蝶或经颅入路，肿瘤全切除和次全切除率７０％，视力改善率７６％，死亡率１．３％。以经蝶入路手术效果为好。５０例平均随访５４．５个月，生活自理４３例，复发５例。术后放疗者垂体功能低下发生率５０％。结论 老年人垂体瘤病程长，肿瘤大，临床以视路改变为主。ＣＴ、ＭＲＩ可帮助早期诊断。经蝶显微手术为首选治疗。需注意放疗后垂体功能低下的并发症。

Objective To study the clinic, the diagnostic and the therapeutic features of pituitary adenomas in elderly pa- tients. Methods Retrospective analysis of 80 elderly patients with pituitary adenomas. Results Average illness duration was 3.6 years. Visual dysfunction existed in 66(82.5%), endocrine abnormality in 36, headachein 30, and other accompanied diseases in 56(70%). CT or MRI confirmed macroadeomas in 78 cases (97.5%). The operations were performed through transsphenoidal or transfrontal approach. The total and subtotal excision rate were 70%, visual improvement rate was 71%, and mortality rate was 1. 3%. The operative resutls through transsphenoidal approach was superior to the transfrontal approach. 50 cases were followed-up for an average of 54.5 months, 43 of them could live by themselves, and 5 suffered from recurrence. The occurrence rate of pitu- itary insufficiency after radiotherapy was 50%. Conclusions For elderly patients with pituitary adenomas, the illness duration was long, the tumors were usually large, and the major presentation were visual changes. It is effective to use CT or MRl for early diagnose. Transsphenoidal microsurgery is the first choice for treatment in elderly patients. Attention to the complication of pituitary insufficiency should be paid to the patients treated with radiotherapy.