GH大腺瘤与非GH大腺瘤鞍外生长方式的比较
发布时间：2019-04-02 18:54
【摘要】：目的：在临床诊疗过程中我们发现垂体腺瘤的病理类型不同，肿瘤的生长方式也有差异。我们的目的是通过对比分析GH垂体大腺瘤与非GH大腺瘤鞍外侵袭的方式，以了解不同病理类型垂体腺瘤鞍外侵袭的差异。 方法：我们回顾性分析了2008年12月至2013年3月间因头痛、视力视野障碍、面容改变等来北京天坛医院行手术治疗的垂体大腺瘤患者，所有患者均于我院行术前头颅CT及MRI检查并经术后病理证实。微腺瘤患者及有手术史的患者均排除。由此可得生长激素细胞（GH）垂体大腺瘤患者100例，促肾上腺皮质激素细胞（ACTH）垂体大腺瘤患者32例，，促卵泡刺激素细胞（FSH）垂体大腺瘤患者53例，促黄体素细胞（LH）垂体大腺瘤患者4例，促甲状腺素细胞（TSH）垂体大腺瘤患者16例，泌乳素细胞（PRL)垂体大腺瘤患者46例及随机选取的无功能性腺瘤（NFMAs）患者50例。术前CT检测包括轴位、矢状位及冠状位薄层扫描，观察鞍区形态，鞍底、前床突及鞍背骨质破坏情况。术前头部MRI检测包括鞍区轴位、矢状位及冠状位平扫+增强，了解垂体瘤的大小、形态、生长方向及与邻近海绵窦、视交叉等结构的关系。对比分析GH大腺瘤与非GH大腺瘤及其他病理类型垂体大腺瘤的鞍外生长情况。 结果：通过对比研究我们可以得出：1、GH大腺瘤患者与非GH大腺瘤患者相比男女比例无明显差异；2、GH大腺瘤患者初次就诊时肿瘤平均最大直径及平均体积较非GH大腺瘤小；3、GH大腺瘤患者初次就诊的平均年龄较非GH大腺瘤患者小；4、GH大腺瘤较非GH大腺瘤更易向鞍下侵袭，非GH大腺瘤趋向于鞍上生长；5、GH大腺瘤生长方式与非GH大腺瘤的其他病理类型两两比较时多数无明显统计学差异；6.GH大腺瘤与FSH大腺瘤和NFMAs大腺瘤相比，P0.001,FSH大腺瘤和NFMAs大腺瘤更易向鞍上生长；当只考虑仅向鞍下生长时，GH大腺瘤较其他两者更明显；7、当对比腺瘤自身各生长方向时，我们发现GH腺瘤、ACTH腺瘤、PRL腺瘤及NFMAs腺瘤更易向鞍下生长；FSH腺瘤较易向鞍下或鞍上生长；LH腺瘤及TSH腺瘤向各方向生长无统计学差异。 结论：通过对比研究GH大腺瘤与非GH大腺瘤可知，不同病理类型的垂体大腺瘤鞍外生长具有显著的特异性。GH腺瘤患者发病后就诊的年龄较非GH腺瘤小，而且肿瘤直径及体积也较小。尽管体积较小，但是GH大腺瘤较易向鞍下侵袭，而非GH腺瘤体积较大而易向鞍上生长。
[Abstract]:Objective: in the course of clinical diagnosis and treatment, we found different pathological types of pituitary adenomas and different growth patterns of pituitary adenomas. The purpose of this study was to compare the extraSellar invasion of GH pituitary macroadenomas and non-GH large adenomas in order to understand the differences in extraSellar invasion of different pathological types of pituitary adenomas. Methods: from December 2008 to March 2013, we retrospectively analyzed the patients with pituitary macroadenoma who came to Beijing Tiantan Hospital for surgical treatment due to headache, visual field disturbance and face change. All patients were examined by CT and MRI before operation in our hospital and proved by pathology. Patients with microadenomas and patients with a history of surgery were excluded. The results showed that there were 100 patients with (GH) pituitary macroadenoma, 32 patients with (ACTH) hypophyseal macroadenoma, 53 patients with (FSH) pituitary macroadenoma with follicle stimulating hormone cell, and 32 patients with gonadotropin cell (ACTH) pituitary macroadenoma, and 53 patients with gonadotropin cell (FSH) pituitary macroadenoma. There were 4 cases of luteinizing (LH) pituitary macroadenoma, 16 cases of thyrotropin cell (TSH) pituitary macroadenoma, 46 cases of prolactin cell (PRL) pituitary macroadenoma and 50 cases of non-functional adenoma (NFMAs). Preoperative CT examination included axial, sagittal and coronal thin-slice scanning to observe the shape of the Sellar region, the destruction of the Sellar floor, the anterior process of the bed and the back of the Sella. Preoperative MRI of the head included axial, sagittal and coronal plain enhancement of the Sellar region to understand the size, shape, growth direction of pituitary adenoma and its relationship with adjacent cavernous sinus and optic chiasma. The extraSellar growth of GH macroadenomas and non-GH macroadenomas and other pathological types of pituitary macroadenomas was analyzed. Results: (1) there was no significant difference in the ratio of GH greater adenomas between men and women compared with non-GH large adenomas; (2) the mean maximum diameter and average volume of GH large adenomas were smaller than those of non-GH large adenomas at the first visit, and the mean age of GH large adenomas was smaller than that of non-GH large adenomas. (4) GH greater adenomas were more prone to subSellar invasion than non-GH large adenomas, and non-GH large adenomas tended to grow in the suprasellar region, 5. There was no significant difference in the growth patterns between GH large adenomas and other pathological types of non-GH macroadenomas. Compared with FSH macroadenomas and NFMAs macroadenomas, 6.GH macroadenomas and NFMAs macroadenomas are more likely to grow to the suprasellar region, and when only subSellar growth is considered, GH macroadenomas are more obvious than those of the other two adenomas, and P0.001FSH macroadenomas and NFMAs macroadenomas are more likely to grow to the suprasellar region. 7. We found that GH adenomas, ACTH adenomas, PRL adenomas and NFMAs adenomas were more prone to subSellar growth, FSH adenomas were more prone to subSellar or suprasellar growth, and LH adenomas and TSH adenomas were not significantly different from those of TSH adenomas. Conclusion: a comparative study of GH macroadenomas and non-GH macroadenomas shows that the extraSellar growth of different pathological types of pituitary macroadenomas has significant specificity. The age of patients with GH adenomas after onset is younger than that of non-GH adenomas. The diameter and volume of the tumor were also smaller. In spite of its small size, GH adenomas are more likely to invade the subSellar region, while non-GH adenomas are larger in size and easier to grow into the suprasellar region.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.41
本文编号：2452825
[Abstract]:Objective: in the course of clinical diagnosis and treatment, we found different pathological types of pituitary adenomas and different growth patterns of pituitary adenomas. The purpose of this study was to compare the extraSellar invasion of GH pituitary macroadenomas and non-GH large adenomas in order to understand the differences in extraSellar invasion of different pathological types of pituitary adenomas. Methods: from December 2008 to March 2013, we retrospectively analyzed the patients with pituitary macroadenoma who came to Beijing Tiantan Hospital for surgical treatment due to headache, visual field disturbance and face change. All patients were examined by CT and MRI before operation in our hospital and proved by pathology. Patients with microadenomas and patients with a history of surgery were excluded. The results showed that there were 100 patients with (GH) pituitary macroadenoma, 32 patients with (ACTH) hypophyseal macroadenoma, 53 patients with (FSH) pituitary macroadenoma with follicle stimulating hormone cell, and 32 patients with gonadotropin cell (ACTH) pituitary macroadenoma, and 53 patients with gonadotropin cell (FSH) pituitary macroadenoma. There were 4 cases of luteinizing (LH) pituitary macroadenoma, 16 cases of thyrotropin cell (TSH) pituitary macroadenoma, 46 cases of prolactin cell (PRL) pituitary macroadenoma and 50 cases of non-functional adenoma (NFMAs). Preoperative CT examination included axial, sagittal and coronal thin-slice scanning to observe the shape of the Sellar region, the destruction of the Sellar floor, the anterior process of the bed and the back of the Sella. Preoperative MRI of the head included axial, sagittal and coronal plain enhancement of the Sellar region to understand the size, shape, growth direction of pituitary adenoma and its relationship with adjacent cavernous sinus and optic chiasma. The extraSellar growth of GH macroadenomas and non-GH macroadenomas and other pathological types of pituitary macroadenomas was analyzed. Results: (1) there was no significant difference in the ratio of GH greater adenomas between men and women compared with non-GH large adenomas; (2) the mean maximum diameter and average volume of GH large adenomas were smaller than those of non-GH large adenomas at the first visit, and the mean age of GH large adenomas was smaller than that of non-GH large adenomas. (4) GH greater adenomas were more prone to subSellar invasion than non-GH large adenomas, and non-GH large adenomas tended to grow in the suprasellar region, 5. There was no significant difference in the growth patterns between GH large adenomas and other pathological types of non-GH macroadenomas. Compared with FSH macroadenomas and NFMAs macroadenomas, 6.GH macroadenomas and NFMAs macroadenomas are more likely to grow to the suprasellar region, and when only subSellar growth is considered, GH macroadenomas are more obvious than those of the other two adenomas, and P0.001FSH macroadenomas and NFMAs macroadenomas are more likely to grow to the suprasellar region. 7. We found that GH adenomas, ACTH adenomas, PRL adenomas and NFMAs adenomas were more prone to subSellar growth, FSH adenomas were more prone to subSellar or suprasellar growth, and LH adenomas and TSH adenomas were not significantly different from those of TSH adenomas. Conclusion: a comparative study of GH macroadenomas and non-GH macroadenomas shows that the extraSellar growth of different pathological types of pituitary macroadenomas has significant specificity. The age of patients with GH adenomas after onset is younger than that of non-GH adenomas. The diameter and volume of the tumor were also smaller. In spite of its small size, GH adenomas are more likely to invade the subSellar region, while non-GH adenomas are larger in size and easier to grow into the suprasellar region.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.41
【参考文献】
相关期刊论文 前1条
1 王欣;张雪君;;垂体生长激素腺瘤的MRI特点[J];天津医科大学学报;2012年04期
本文编号：2452825
本文链接：https://www.wllwen.com/yixuelunwen/shenjingyixue/2452825.html
最近更新
教材专著
