岩下窦静脉取血在MRI阴性的库欣病患者围手术期中的应用

Use of inferior petrosal sinus sampling during the perioperative periodtreatment of Cushing＆#39;s disease with negative magnetic resonance imaging

目的 总结分析岩下窦静脉取血（IPSS）在MRI阴性的库欣病围手术期中的应用.方法 回顾性分析北京协和医院神经外科2012年8月至2014年8月79例MRI阴性的库欣病患者,其中58例行IPSS,女42例,男16例,年龄（36±130）岁.58例患者均行内分泌评估后经蝶窦入路手术,标本送病理检查.结果 58例IPSS结果均提示ACTH分泌为垂体源性.术前根据IPSS结果预测肿瘤侧别,29例术中探查位置与术前预测相同,阳性预测值为50％（29/58）.47例术中为典型灰白色肿瘤者内分泌缓解率为83.0％;9例术中为可疑肿瘤者内分泌缓解率为44.4％,2例术中未见肿瘤者均未缓解.58例患者41例（70.7％）病理学诊断为垂体腺瘤,5例为垂体前叶增生,12例为垂体前、后叶.结论 对于MRI阴性的库欣病患者,建议行IPSS,其对判断ACTH分泌是否为垂体源性有决定意义,但对肿瘤侧别的预测意义不大.如IPSS结果为阳性,应首选经蝶窦入路手术,术中鞍内应彻底探查.

Objective To analyze inferior petrosal sinus sampling （IPSS） in diagnosis and treatment of Cushing＇s disease with negative magnetic resonance imaging （MRI）.Methods We retrospectively reviewed 79 cases of Cushing＇s disease with negative MRI in the Department of Neurosurgery of Peking Union Medical College Hospital from August 2012 to August 2014.Of the 79 patients,58 underwent IPSS.There were 16 males and 42 females in this study,with age 12 to 65 years old.All 58 patients underwent endocrine assessment before transsphenoidal surgery,and pathology specimens were examined.Results The IPSS results of all the 58 patients suggested the excessive secretion of ACTH was from pituitary.Of the 58 patients,visible tumor was found in 56 cases during intraoperative exploration （96.6%）.In 29 （50%） cases,the sideof pituitary where tumor was located predicted by IPSS was the same with intraoperative exploration.Typical tumorwas seen in 47 cases during exploration,and the endocrine remission rate was 83.0% after operation.Suspicious tumor was seen in 9 cases,and endocrine response rate was 44.4%.No tumor was found in two caseswhohad no remission after operation.Pituitary adenoma was confirmed in 41 patients （70.7%） by pathological exam.And anterioror posterior lobe of pituitary was reported in 12 cases,pituitary hyperplasia in 5 cases.Conclusions IPSS is recommended in Cushing＇s disease patients with negative MRI,and it is helpfulto judge whether the excessivesecretion of ACTH is from pituitary,whileits value in predicting the lateralization of tumor is low.If IPSS results are positive,transsphenoidal surgery should be performed.