合并糖尿病的垂体腺瘤的外科治疗

Surgical treatment of pituitary adenoma in patients complicated with diabetes mellitus

目的 总结分析合并糖尿病的垂体腺瘤的外科治疗效果。方法 回顾分析1990年至2000年收治的43例合并糖尿病的垂体腺瘤患者的资料,生长激素腺瘤29例,泌乳素腺瘤8例,无功能性腺瘤6例;经额入路11例,翼点入路28例,蝶窦入路5例;围手术期严密监测并控制血糖。结果 肿瘤全切除31例(72.1％),次全切除8例(20.9％),大部分切除4例(7％);术后32例血糖恢复正常;绝大多数患者手术后恢复良好,仅1例死于尿崩症。结论 合并糖尿病的垂体腺瘤患者的病情复杂,选择合适的手术方法,力争全切肿瘤,以及围手术期的正确处理,是获得良好预后的关键。

Objective To analyze the effect of surgical treatment of pituitary adenoma in patients complicated with diabetes mellitus(PACDM). Methods A total of 43 cases of PACDM admitted from 1990 to 2000 were analyzed retrospectively, of which 29 cases were diagnosed as GH secreting adenoma, 8 as PRL-secreting adenoma, 6 as nonfunctioning adenoma. 11 cases were operated by transsubfrontal approach, 28 by transpterional approach, 5 by transsphenoidal approach. In the perioperational period, all patients' blood sugar were monitored and controlled with insulin. Results Total removal of tumor was achieved in 31 cases of 43 patients (72.1%), subtotal removal were done in 8 cases (20.9%) and partial removal in 4 cases (7%). Postoperative blood sugar restored to normal level in 32 patients. All patients recovered after operation except 1 case died of diabetes insipidus. Conclusion Manifestation of PACDM is rather complex. The key measures are choosing appropriate method of operation to remove tumor totally and treating diabetes mellitus effectively in the perioperational period.