经鼻蝶窦垂体瘤切除术对合并心肌病患者血清生长激素水平及心脏结构功能的影响分析

Analysis on influence of transsphenoidal approach pituitary adenoma resection in patients with complicating cardiomyopathy on serum growth hormone level and cardiac structural function

目的研究生长激素型垂体瘤合并心肌病患者外科手术治疗及临床疗效。方法选取该院2012年6月至2016年6月收治的65例生长激素型垂体腺瘤伴心肌病患者,所有患者均采取经鼻鼻蝶窦手术入路切除垂体瘤,观察术后2周血清生长激素水平、心电图结果、超声心电图结果及临床症状。结果术后患者体征均有明显改善,肢端肥大及鼻唇肥厚明显改善,头晕乏力、高血压及高血糖等均得到显著改善;术后平均生长激素水平为(4.37±2.03)μg/L,显著低于术前的(40.27±4.18)μg/L,差异有统计学意义(P<0.01);患者术后的室间隔厚度(IVST)、左室舒张末期内径(LVIDd)和左室后壁厚度(LVPWT)均显著低于术前,差异有统计学意义(P<0.01);患者术后的平均二尖瓣血流频谱(E/A)和左室射血分数(LVEF)明显低于术前,差异有统计学意义(P<0.01)。结论经鼻蝶窦垂体瘤切除术能降低患者生长激素水平,改善心脏功能。

Objective To study the surgical treatment and clinical effect of growth hormone type pituitary tumor complicating cardiomyopathy.Methods Sixty-five cases of growth hormone type pituitary adenoma complicating cardiomyopathy in the hospital from June 2012 to June 2016 were selected and performed transsphenoidal approach pituitary adenoma resection.Then serum growth hormone level,ECG results,ultrasound cardiogram results and clinical symptoms were observed at 2 weeks after operation.Results The signs were significantly improved after surgery,acromegaly and nasolabial hypertrophy were significantly improved,dizziness,fatigue,hypertension and hyperglycemia were significantly improved;the average postoperative growth hormone level was（4.37±2.03）μg/L,which was significantly lower than（40.27±4.18）μg/L before operation,and the difference was statistically significant（P〉〉〈0.01）;postoperative IVST,LVIDd and LVPWT were significantly lower than those before operation,and the difference was statistically significant（P〈0.01）;postoperative average E/A and LVEF were significantly lower than those before operation,and the difference was statistically significant（P〈0.01）.Conclusion Transsphenoidal pituitary tumor resection can reduce the level of growth hormone and improves the cardiac function.