垂体泌乳素微腺瘤围手术期糖皮质激素补充治疗的探讨

Perioperative glucocorticoid replacement for pituitary microprolactinoma through transsphenoidal resection

目的探讨经蝶窦入路显微手术切除垂体泌乳素微腺瘤技术与围手术期激素变化的相关性及补充治疗的必要性,及基于假性包膜术式对病人垂体功能保护的临床意义。方法将75例垂体泌乳素微腺瘤病人随机分组,对照组(n=25):术前及术后均不使用激素;术前激素组(n=25):术前常规使用激素,术后不使用;围手术期激素组(n=25):术前及术后常规使用激素。所有病人行导航(或)内镜辅助经蝶窦显微切除术,术后随访及收集资料并进行分析。结果平均随访12个月,镜下肿瘤全切率100%,治愈率达94.67%。组间术前、术后3 d、术后1个月、术后3个月8AM血清皮质醇未见统计学差异(P>0.05),随访未见垂体功能低下。结论垂体泌乳素微腺瘤经蝶窦基于假性包膜外显微切除疗效显著,手术并发症少,对正常垂体功能干扰小,围手术期是否常规激素补充还值得进一步探讨。

Objective To explore the correlation between microsurgical techniques for pituitary microprolactinoma via transsphenoidal resection and perioperative hormone alterations and the necessity of glucocorticoid supplement therapy, and the clinical significance of this pseudocapsule-based extracapsular transsphenoidal microsurgery for protecting the pituitary function. Methods Seventy-five patients with pituitary microprolactinoma were prospectively randomly divided into 3 groups, control group（ n = 25） without perioperative glucocorticoid replacement, preoperative glucocorticoid group（n = 25） with only preoperative conventional glucocorticoid replacement, perioperative glucocorticoid group（ n = 25） with perioperative glucocorticoid replacement. All patients underwent neuronavigation- or endoscope-assisted transsphenoidal microsurgery and were followed up for 12 months in average and clinical data analyzed retrospectively. Results All the tumors were totally resected under the microscope. The cure rate achieved 94.67%. There was no statistical difference in 8AM cortisol levels between 3 groups before, 3 d, 1 month, 3 months after surgery（ P〉0. 05）. No hypopituitarism was observed in the follow-up period. Conclusions The neuronavigation-assisted pseudocapsule-based extracapsular transsphenoidal microsurgery for microprolactinoma can achieve significant therapeutic outcome and reduce the disturbance for normal pituitary function with less complications. The necessity of perioperative conventional hormone replacement is worthy of further exploration.