[1]郭晓鹏　赵羽西　高　路　姚　勇　邓　侃　连　伟　王任直　幸　兵.经蝶手术治疗垂体生长激素腺瘤合并空蝶鞍综合征疗效分析[J].中国临床神经外科杂志,2015,(05):265-267,270.[doi:10.13798/j.issn.1009-153X.2015.05.003]
　GUO Xiao-peng,ZHAO Yu-xi,GAO Lu,et al.Therapeutic effects of transsphenoidal microsurgery on growth-hormone-secreting pituitary adenomas associated with empty sella syndrome (report of 41 cases)[J].,2015,(05):265-267,270.[doi:10.13798/j.issn.1009-153X.2015.05.003]
点击复制

经蝶手术治疗垂体生长激素腺瘤合并空蝶鞍综合征疗效分析()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2015年05期
页码:
265-267,270
栏目:
论著
出版日期:
2015-05-30

文章信息/Info

Title:
Therapeutic effects of transsphenoidal microsurgery on growth-hormone-secreting pituitary adenomas associated with empty sella syndrome (report of 41 cases)
文章编号:
1009-153X（2015）05-0265-03
作者:
郭晓鹏　赵羽西　高　路　姚　勇　邓　侃　连　伟　王任直　幸　兵
100730，北京协和医院神经外科
通讯作者：幸　兵，E-mail：xingbingemail@aliyun.com
Author(s):
GUO Xiao-peng;  ZHAO Yu-xi;  GAO Lu;  YAO Yong;  DENG Kan;  LIAN Wei;  WANG Ren-zhi;  XING Bing.
Department of Neurosurgery, Peking Union Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China
关键词:
垂体生长激素腺瘤; 肢端肥大症; 空蝶鞍综合征; 经蝶显微手术
Keywords:
Growth-hormone-secreting pituitary adenomas;  Acromegaly;  Empty sella syndrome;  Transsphenoidal microsurgery
分类号:
R 739.41; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2015.05.003
文献标志码:
A
摘要:
目的 探讨垂体生长激素（GH）腺瘤合并空蝶鞍综合征（ESS）的手术方法及其疗效。方法 回顾性分析2010年1月至2013年12月经蝶入路手术治疗的41例垂体GH腺瘤合并ESS患者的临床资料。所有患者术后随访1~4年，平均2.3年；空腹或随机血清GH<2.5 ng/ml，或GH葡萄糖抑制试验示GH谷值<1 ng/ml为治愈标准。结果 术后6个月治愈32例（78.0%），未愈9例（22.0%）。随访期间32例治愈患者均未复发；9例未愈患者中，1例行放疗，其随机GH未降至正常水平、GH葡萄糖抑制试验GH谷值>1 ng/ml，其他8例患者未行特殊治疗患者中3例治愈。术后发生并发症13例（31.7%，13/41），其中一过性电解质紊乱12例（低钾血症8例，低钠血症3例，高钠血症1例），一过性尿崩症4例，脑膜炎1例，经积极治疗均痊愈出院。结论 经蝶手术是垂体GH腺瘤合并ESS患者的有效治疗方法。
Abstract:
Objective To discuss the surgical method to treat the growth-hormone-secreting pituitary adenomas (GHSPA) associated with empty sella syndrome (ESS), microsurgical effects on them and postoperative complications. Methods The clinical data of 41 patients with GHSPA associated with ESS, who were treated by transsphenoidal microsurgery from January, 2010 to December, 2013, were analyzed retrospectively. Of 41 cases of GHSPA, 23 were type A GHSDPA which referred to GHPSA beneath the cavum subarachnoidale, 12 were type B which to GHSPA lateral to the cavum subarachnoidale and 6 were type C which to GHSPA encircled by the cavum subarachnoidale. Results Following-up from 1 to 4 years showed that the cured rates of types A, B, and C GHSPA were 91.3% (21/23), 83.3% (10/12), and 66.7% (4/6) respectively according to the postoperative serum levels of growth hormone suppression test and insulin growth factor-1. The overall postoperative complications rate was 31.7% (13/41). Conclusions The transsphenoidal microsurgery is a good method to treat GHSPA associated with ESS and its curative effect on GHSPA associated with ESS is good.

参考文献/References:

[1] 李士其，王镛斐，赵　曜，等. 经蝶显微手术治疗垂体腺瘤 3375例[J]. 中国临床神经外科杂志，2005，10（6）：403- 406.
[2] Mehta GU, Bakhtian KD, Oldfield EH. Effect of primary empty sella syndrome on pituitary surgery for Cushing’s disease [J]. J Neurosurg, 2014, 121(3): 518-526.
[3] Yuh WT, Zhu M, Taoka T, et al. MR imaging of pituitary morphology in idiopathic intracranial hypertension [J]. J Magn Reson Imaging, 2000, 12(6): 808-813.
[4] 中华医学会神经外科学分会，中国垂体腺瘤协作组，中华 医学会内分泌学分会. 中国肢端肥大症诊治指南（2013） [J]. 中华神经外科杂志，2013，29（10）：975-979.
[5] Liu W, Zhou H, Neidert MC, et al. Growth hormone secreting pituitary microadenomas and empty sella--an under- recognized association [J]? Clin Neurol Neurosurg, 2014, 126: 18-23.
[6] Pinar E, Yuceer N, Imre A, et al. Endoscopic endonasal transsphenoidal surgery for pituitary adenomas [J]. J Cra- niofac Surg, 2014, 26(1): 1-5.
[7] Sharma M, Ambekar S, Sonig A, et al. Factors predicting the development of new onset post-operative hydrocephalus following trans-sphenoidal surgery for pituitary adenoma [J]. Clin Neurol Neurosurg, 2013, 115(10): 1951-1954.
[8] Messerer M, De Battista JC, Raverot G, et al. Evidence of improved surgical outcome following endoscopy for nonfun- ctioning pituitary adenoma removal [J]. Neurosurg Focus, 2011, 30(4): 1-9.
[9] 杨　义，任祖渊，苏长保，等. 经蝶窦入路垂体腺瘤切除术 中脑脊液漏的影响因素和修补方法[J]. 中华神经外科杂 志，2009，25（1）：8-11.
[10] Han ZL, He DS, Mao ZG, et al. Cerebrospinal fluid rhinorr- hea following trans-sphenoidal pituitary macroadenoma surgery: experience from 592 patients [J]. Clin Neurol Neurosurg, 2008, 110(6): 570-579.
[11] 杨立坚. 经单鼻孔蝶窦入路垂体瘤切除手术后并发症多 因素回归分析[J]. 中国现代医学杂志，2010，20（5）：763- 765.

相似文献/References:

[1]傅　炜　卞留贯　陈　晓　钟志宏　孙昱皓　孙青芳.垂体生长激素腺瘤经蝶手术预后的影响因素分析[J].中国临床神经外科杂志,2015,(10):584.[doi:10.13798/j.issn.1009-153X.2015.10.003]
　FU Wei,BIAN Liu-guan,CHEN Xiao,et al.Analysis of factors related to prognoses in patients with growth hormone-secreting pituitary adenomas after transsphenoidal surgery[J].,2015,(05):584.[doi:10.13798/j.issn.1009-153X.2015.10.003]
[2]陈　曦　陈　娟　谢蕊繁　徐　钰　胡　航　李　然　叶　飞　雷　霆.人脑垂体生长激素腺瘤PKCδ、ERK1/2、gsp癌基因的表达关联性分析[J].中国临床神经外科杂志,2015,(04):225.[doi:10.13798/j.issn.1009-153X.2015.04.011]
　CHEN Xi,CHEN Juan,XIE Rui-fan,et al.Expressions gsp oncogene, PKCδ and ERK1/2 in human somatotrophinomas and relationship among them[J].,2015,(05):225.[doi:10.13798/j.issn.1009-153X.2015.04.011]
[3]林伟标　林少华.神经内镜与显微镜下经鼻蝶入路手术治疗垂体生长激素腺瘤[J].中国临床神经外科杂志,2018,(08):554.[doi:doi:10.13798/j.issn.1009-153X.2018.08.015]
[4]罗　谦　姜　曙　周培志　蔡博文.培维索孟治疗肢端肥大症疗效的系统评价[J].中国临床神经外科杂志,2015,(10):591.[doi:10.13798/j.issn.1009-153X.2015.10.005]
　LUO Qian,JIANG Shu,ZHOU Pei-zhi,et al.Curative effect of pegvisomant on acromegaly: a systematic review[J].,2015,(05):591.[doi:10.13798/j.issn.1009-153X.2015.10.005]

更新日期/Last Update: 2015-05-30