垂体性Cushing病的再手术

Reoperation for Cushing＇s disease

目的 探讨再手术的垂体性Cushing病手术适应证及手术技巧.方法 回顾分析再次手术的垂体性Cushing病16例（初次手术后不缓解8例、复发的8例）,再次手术前内分泌评估仍然是垂体性Cushing病;均采用经蝶窦手术,术中鞍底广泛暴露、鞍内探查广泛,有肿瘤者选择性肿瘤切除,同时肿瘤周边垂体低功率电凝电灼;没有明显肿瘤者,在原有肿瘤侧半垂体切除;若原有病理提示垂体增生或正常垂体,做次全（全）垂体切除.结果 术后缓解11例（69％）,不缓解与复发患者、再手术前垂体MRI是否发现肿瘤之间的缓解率差异无统计学意义（P＞0.05）.结论 复发（不缓解）垂体性Cushing病再手术前的内分泌评估很重要,再次手术是治疗的选择,但建议治疗在拥有完善内分泌诊断条件和丰富垂体腺瘤手术治疗经验的垂体中心治疗.

Objective To study the surgical indications and techniques of reoperation of pituitary for the treatment of recurrent/persistent pituitary Cushing＇s disease after the first surgery.Method Sixteen patients with recurrent （n =8）/persistent （n =8） Cushing＇s disease,who underwent the reoperation of pituitary from Jan.2006 to Apr.2014 were retrospectively analyzed.Before the reoperation,all the patients were diagnosed as Cushing＇s disease by endocrine assessment.Then,the transsphenoid surgery was performed and the pituitary was explored completely with wide exposure of sellar.If the tumor was identified,tumor resection with low frequency coagulation of the pituitary adjacent to the tumor was performed.Whereas there was no tumor,but the tumor was identified at the first surgery,hemihypophysectomy at the original tumor site was recommended.On the other hand,if there was no tumor,and the original pathology suggested hyperplasia or normal pituitary tissue,hypophysectomy or subtotal hypophysectomy was recommended.Results Immediate postoperative remission was achieved in 11 patients （69%）.There was no difference of remission rate between persistent and recurrent cases,and between whether the preoperative pituitary MRI indicated tumor or not （P〉0.05）.Conclusions The endocrine evaluation for recurrent/persistent pituitary Cushing＇s disease before reoperation was important.Reoperation was the choice of treatment for persistent/recurrence pituitary Cushing＇s disease.It was recommended that reoperation should be carried out in a professional pituitary center,with perfect diagnosis of endocrine conditions and rich experience in the surgical treatment of pituitary adenoma.