摘要
目的回顾分析垂体促肾上腺皮质激素(ACTH)微腺瘤诊断和手术治疗结果。方法1983年9月至2009年12月经蝶手术治疗ACTH微腺瘤230例。术前内分泌学检查患者均见血尿皮质醇水平增高,昼夜节律消失;地塞米松抑制试验:小剂量(2 mg)不抑制97%(223/230例);大剂量(8 mg)抑制89.5%(220/230例)。术前影像学(CT/MRI)检查结果:阳性占67%(154/230例),阴性占33%(76/230例)。结果随访2～26年,平均6.7年。其中根治196/230例(85%),未根治34例(15%)结论垂体微腺瘤0级(≤4 mm)在CT/MRI上多未能发现。大部分病例可在术中探查到肿瘤,其中最小者仅2 mm大小。术中冰冻切片示垂体增生者可行垂体次全切除术。
Objective To analyze retrospectively long-term results of surgical treatment of pituitary adreno- cortico-tropic-hormone （ACTH） microadenoma. Methods From September 1983 to December 2009, two hundred and thirty cases of pituitary ACTH micmadenoma had been operated in our department. The criterion of inclusion in this study including： Cushing＇s symptom with increased serum and urinary cortisol level; lose of nocturnal rhythm of cortisone secretion; negative on small doze （2 nag） dexamethasone （Dx） suppression test （sensitivity of 97% , 223/230 cases） and positive on large doze （8 mg） Dx suppression test （sensitivity of 89. 5%, 220/230）. Pre-operative image study including dynamic CT and MR/showed microadenoma in 67% of cases （154/230） and negative in remaining 76 cases （33%）. Results All the cases were followed up for 2 -26 years with a mean of 6.7 years. The cure rate was 85% （196/230）. Thirty-four cases obtained no obvious remission or recurred after a certain period. Conclusion Near one third of ACTH microadenoma are imaging （CT/MRI） negative mieroadenoma （grade 0）. For the patients with definite clinical and endocrinological evidence, operation is always indicated. During surgical exploration the adenoma can be found in most cases, with a diameter as smaller as 2 mm. If intra-operative pathological frozen section shows the pituitary proliferation, semi-hypophysectomy is indicated to assure the symptom relief.
出处
《中华神经外科疾病研究杂志》
CAS
2012年第2期149-151,共3页
Chinese Journal of Neurosurgical Disease Research
关键词
库欣病
微腺瘤
经蝶手术
根治
Cushing＇s disease
Microadenoma
Transsphenoidal approach
Radical cure
