垂体偶发瘤的临床处理

Clinical diagnosis and management of pituitary incidentalomas

目的：探讨垂体偶发瘤的临床特点和诊治方法。方法回顾性分析2008年1月至2013年12月收治的53例垂体偶发瘤患者的临床资料。结果41例有头痛等症状，12例无任何症状。4例有内分泌功能；无功能型49例病灶小于1.0 cm者27例，1.0-1.5 cm者13例，大于1.5 cm者9例；29例经鼻蝶手术切除病变，术后病理结果示垂体腺瘤21例（18例无功能，2例生长激素型，1例泌乳素型），3例垂体增生，3例Rathke囊肿，2例垂体囊肿。53例中，失访4例；49例病人随访1-5年，手术切除病例均无复发，保守治疗病例中2例增大，其余病例无变化。结论对于头痛病人需重视垂体MRI检查；对于大于1.5 cm或1.0-1.5 cm随访有增大者，建议手术切除；而1.0 cm以下无内分泌功能者可以定期随访。

Objective To explore the methods to diagnose and treat the pituitary incidentalomas. Method The clinical data of 53 patients with pituitary incidentalomas found by MRI from January, 2008 to December, 2013 were analyzed retrospectively. Results Of these 53 patients, 41 had symptoms including headaches, dizziness, fainting, visual dysfunction, cerebral infarct and so on and 12 not. There were the mild endocrine disorders in 4 patients. The diameters of the lesions were less than 1.0 cm in 31 patients, between 1.0 and 1.5 centimeters in 13 and more than 1.5 cm in 9. The pathological examination showed that of 29 patients who underwent endonasal transsphenoidal surgery, 18 suffered from nonfunctioning pituitary adenomas, 2 from growth hormone pituitary adenomas, 3 from pituitary hyperplasia, 3 from Rathke cysts, 2 from pituitary cysts and 1 from prolactinoma. Of 49 patients followed up for more than 1 year, 29 undergoing the surgery did not suffer from the recurrence of the lesions, 18 had unchanged pituitary lesions and 2 who did not undergo surgery had enlargement of the pituitary lesions. Of 2 patients with enlarged lesions, 1 received surgical treatment and 1 was continuously observed. Conclusion MRI examination of the pituitary bodies should be performed in the patients with headaches. Surgery is recommended in the patients with pituitary incidentaomas which are more than 1.0 cm in diameters. The regular following up is recommended in the patients with nonsecreting pituitary incidentalomas which are less than 1.0 cm in diameters.