摘要
目的分析神经内镜经蝶入路手术治疗垂体性库欣病的临床疗效。方法回顾性分析2015年1月至2020年1月华中科技大学同济医学院附属协和医院神经外科收治的133例垂体性库欣病患者的临床资料。所有患者均采用神经内镜经蝶入路手术治疗。术后48 h复查垂体MRI,未发现肿瘤残留定义为完全切除。术后1~2 d和6个月均检测清晨外周血清皮质醇和24 h尿游离皮质醇水平,定期门诊随访临床症状、行影像学检查,以评估疗效。缓解标准参考《中国库欣病诊治专家共识(2015)》中的标准。结果133例患者均顺利完成手术。其中119例(89.5%)术后病理学结果为垂体腺瘤或增生,另14例(10.5%)为正常垂体组织。术后出现一过性尿崩症19例、永久性尿崩症2例、电解质紊乱21例、垂体功能低下32例、脑脊液漏4例、术区出血2例、颅内感染2例。术前MRI发现垂体腺瘤的101例患者肿瘤均完全切除,垂体微腺瘤患者术后即刻缓解率为90.1%(73/81),大腺瘤患者术后即刻缓解率为60.0%(12/20);32例术前MRI结果阴性的患者中,术中探查发现可疑垂体腺瘤患者(肿瘤均完全切除)的缓解比例为14/18,未发现肿瘤患者的缓解比例为6/14。患者的术后即刻总缓解率为78.9%(105/133)。133例患者的术后随访时间为(2.5±0.3)年(1~6年)。术后6个月随访时,术后未即刻缓解的28例患者中,8例患者达延迟缓解,4例经再次治疗缓解,16例未缓解。至末次随访,105例术后即刻缓解的患者中24例(22.9%)复发,复发时间为术后(2.7±0.4)年(0.5~6.0年),4例经治疗后再次达到缓解。结论神经内镜经蝶入路手术治疗垂体性库欣病疗效较好,但术后并发症较多且易复发。
Objective To analyze the clinical effect of endoscopic transsphenoidal surgery for the treatment of Cushing′s disease.Methods A retrospective analysis was conducted on the clinical data of 133 patients with pituitary Cushing′s disease admitted to the Department of Neurosurgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2015 to January 2020.All patients were treated with neuroendoscopic transsphenoidal surgery.Gross total resection(GTR)was defined as no residual tumor in MRI 48 hours after surgery.The levels of peripheral serum cortisol and 24-hour urine free cortisol were measured at 1 to 2 days and 6 months after surgery.Clinical symptoms and imaging examinations were followed up regularly to evaluate the efficacy.The criteria for remission was defined according to"Chinese Experts Consensus on the Diagnosis and Treatment of Cushing′s Disease(2015)".Results All 133 patients successfully underwent the operation.Among them,119 cases(89.5%)had postoperative pathological results suggesting pituitary adenoma or hyperplasia,and the other 14 cases(10.5%)were normal pituitary tissues.There were 19 cases of transient diabetes insipidus,2 cases of permanent diabetes insipidus,21 cases of electrolyte disturbance,32 cases of hypopituitarism,4 cases of cerebrospinal fluid leakage,2 cases of intraoperative hemorrhage,and 2 cases of intracranial infection.Among 101 patients(all GTR)with pituitary adenomas detected by preoperative MRI,the immediate postoperative remission rate was 90.1%(73/81)for pituitary microadenoma and 60.0%(12/20)for macroadenoma.Among 32 patients with negative preoperative MRI results,the remission ratio was 14/18 in patients with suspected pituitary adenomas identified during operation(all GTR)and 6/14 in those without obvious adenomas.The overall remission rate of patients immediately after surgery was 78.9%(105/133).The postoperative follow-up time of 133 patients was 2.5±0.3 years(1-6 years).At 6 months post operation,of the 28 patients who d
作者
王海均
聂传升
李爽
赵洪洋
姜晓兵
Wang Haijun;Nie Chuansheng;Li Shuang;Zhao Hongyang;Jiang Xiaobing(Department of Neurosurgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430000,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2022年第1期19-23,共5页
Chinese Journal of Neurosurgery
基金
国家自然科学基金(81974390)。
关键词
垂体疾病
自然腔道内镜手术
垂体激素类
治疗结果
库欣病
Pituitary diseases
Natural orifice endoscopic surgery
Pituitary hormones
Treatment outcome
Cushing′s disease
