颅咽管瘤患者手术前后激素变化经验分析
发布时间：2019-06-24 11:16
【摘要】：在本论文的简要概述本组患者的年龄、性别分布、复发模式和激素变化,以往的报道侧重于患者症状而忽视它的实际比率,我们的研究更注重患者激素波动和内分泌疾病。尽管组织学低度恶性,长期随访和并发症的处理具有挑战性。临床症状包括肿瘤在鞍旁生长导致继发于颅内压增高,脑积水,或压迫中枢神经系统的重要结构,引起头痛,恶心,视力模糊,以及多尿和烦渴。它是众所周知,颅咽管瘤通常导致内分泌异常由于其起源部位同下丘脑之间关系密切。 由于肿瘤对下丘脑结构的破坏及各种内分泌失常的治疗反过来对患者的生活质量产生影响。大多数患者(85-95%)遭受多种下丘脑-垂体功能缺陷,包括完成垂体功能不全,而术前缺乏激素全面恢复只发生在极少数情况下,生长激素替代疗法是治疗生长激素缺乏一个被证实的有效、安全的治疗方案。然而,肿瘤对下丘脑结构的破坏和或其治疗的紊乱被认为是贪食和肥胖主要的致病原因,下丘脑损伤程度和后遗症由影像学评估。无论初始手术治疗与手术和／或放射治疗,在随访的过程中内分泌及代谢紊乱更加明显。而术前缺乏激素全面恢复只发生在极少数情况下。通过单变量分析,神经、血管和视觉并发症和患者术后内分泌病变相关,而和患者年龄关系不明显。 因此,为了减少内分泌对患者的影响,我们对患者的内分泌情况进行研究。 目的 ·分析术前和术后颅咽管瘤患者垂体前叶激素的变化。 ·观察平均年龄,性别比例,甲状腺功能减退症在研究样本中的频率。 ·要查看哪些激素对术后患者的整体内分泌不足的比例最大,并帮助采取必要的措施,在未来患者进一步管理中以尽量减少其影响。 ·检讨生长激素在成人颅咽管瘤病人在我们的研究结果。 方法和材料 (一)研究人群/纳入标准： 年龄18年 手术类型：肿瘤整体全切除手术。 手术方式：额外侧入路 单人操作,以减少外科医生的手术技术偏见。 (二)研究设计： 在环湖医院2008至2013年手术治疗的34例成人患者的病历资料进行回顾性研究。 学习的参考值是按照环湖医院实验室。 T3:1.3-3.1nmol/L T4:66-181nmol/L TSH:0.27-4.2UIU/毫升 GH：0.06-5.0纳克/毫升 PRL：2.5-17纳克/毫升 LH:0.8-7.6MIU/毫升 ADH：2.2-14皮克/毫升 促肾上腺皮质激素：0-46皮克/毫升 COR：5-25微克/分升 FSH:0.7-11.7mIU/L 数据采用统计软件包社会科学(SPSS软件版本17.0)进行统计学分析。使用非 参数2依赖性样品测试(Wilcoxon符号秩检验)统计显着性进行了评估。数据以0.05为检验标准。 结果 1.平均年龄及病人的标准偏差纳入本研究分别为(47.11±1.2)岁,平均50岁。 2.女性与男性的比例,在我们的研究为1：1.3 3.甲状腺激素的手术前和手术后激素状态如下：手术前T3,T4, TSH的血浆平均水平分别为2.41nmol/L,48.99nmol/L,2.05uIU/ml,术后T3.T4.TSH分别为1.73nmol/L,23.47nmol/L和0.16UIU/ml。 4.有其他垂体前叶激素水平如下：手术前后LH血浆平均水平分别为3.35MIU/ml和1.78MIU/ml时,泌乳素分别为24.04ng/mL和18.59ng/ml,促肾上腺 皮质激素和生长激素均为是0.372ng/ml和0.34ng/ml,肾上腺皮质激素分别为15.81微克／分升和8.30微克／毫升,FSH分别为是8.94MIU/L和4.87MIU/L.5.T3.T4.TSH.GRH.FSH.LH手术前后的平均血浆值有显著差异,PRL手术前后激素平均值的差异不明显。 讨论：手术前内分泌疾病常见于颅咽管瘤患者。临床特征可能不是很明显,细致的手术前的内分泌评估是必不可少的。未能认识到并解决手术前尿崩症和继受任何手术治疗后会使内分泌功能障碍进一步恶化。研究显示,激素功能障碍的下降趋势。预言这个趋势可以很容易,但要知道激素的模式也是必不可少的。不是所有的激素均往下掉。我们研究了单个激素,得到了各激素的术前和术后的比例。 甲状腺功能和促甲状腺激素：我们对甲状腺激素的研究和以往文献尽管有所不同；甲状腺功能减退症总体发生率在手术前后分别为61%和73.5%(P0.01)。Honegger等人报道,甲状腺功能减退症手术前后的发病率分别为24.5%和38.5%,均较我们的研究要低得多。其结果是基于T3和T4手术后三个月的测量,但我们的结果是根据手术后一周测量。两项研究之间的时间间隔可能有助于解释他们的区别。另一项研究中甲状腺功能减退症在手术前后的发病率分别70%和95%,较我们的研究高,这项研究表明,甲状腺素应全部切除颅咽管瘤术后常规服用。 我们的结果发现TSH是最常见的激素缺乏类型,LH激素缺乏紧随其后。甲状腺激素是最常见的激素功能不全,术前可见于34例患者中的21例；术后可见于34例患者中的25例。LH激素功能障碍见于术前的22例和术后的18例患者。PRL和LH激素缺乏比例在术后发生下降。认真的手术前后内分泌评估是必须的。因此,认识每个患者个别激素的功能减退的趋势是非常重要的。该激素轴与疾病的解剖方面和治疗过程的复杂性要求进一步深入扩大样本的前瞻性研究。 结论 ·激素缺乏似乎是手术的常见并发症。 ·TSH、COR和LH激素缺乏的发生更频繁。 ·甲状腺素和糖皮质激素应作为颅咽管瘤全部切除术后常规处理。 ·我们相信,通过我们的研究和各激素的分析,可以有助于对内分泌失调的理解。 ·这项研究可以作为对这些患者预期成果的估计,并指导决策和促进此领域进一步的研究
[Abstract]:In this paper, the age, sex distribution, recurrence pattern and hormonal changes of the patients were briefly summarized. The previous report focused on the patient's symptoms and ignored the actual ratio, and our study focused more on the patient's hormone fluctuation and the endocrine disease. Long-term follow-up and complications are challenging, despite the low level of histology. Clinical symptoms include an important structure of a tumor that is secondary to intracranial pressure, hydrocephalus, or compression of the central nervous system, resulting in headache, nausea, blurred vision, and polyuria and thirst, secondary to intracranial pressure increase, hydrocephalus, or compression of the central nervous system. It is well known that craniopharyngioma usually results in an abnormal endocrine disorder due to the close relationship between its origin and the hypothalamus. The destruction of the hypothalamic structure and the treatment of various endocrine disorders, in turn, have a shadow on the quality of life of the patient due to the tumor's destruction of the hypothalamic structure and the treatment In response, most patients (85-95%) suffer from a variety of hypothalamic-pituitary functional deficiencies, including the completion of the pituitary function, and the lack of a full recovery of the hormone prior to the procedure occurs only in rare cases where growth hormone replacement therapy is a proven problem for the treatment of growth hormone deficiency effective and safe treatment party Cases. However, the disruption of the hypothalamic structure and the disorder in the treatment of the tumor are considered to be the main cause of the main cause of the gluttony and obesity, and the extent and the sequelae of the hypothalamic injury are assessed by the imaging Assessment of endocrine and metabolic disorders in the follow-up process, regardless of initial surgical treatment and surgery and/ or radiation therapy The absence of a full recovery of the hormone prior to the operation occurs only in a very small number of cases The patient's age relationship was unknown by univariate analysis, neurological, vascular and visual complications, and postoperative endocrine changes in the patient. In order to reduce the effect of the endocrine on the patient, the endocrine condition of the patient line-and-study The purpose of this study was to analyze the pituitary of the patients with craniopharyngioma before and after operation. Changes of the previous leaf hormone. 路 observed mean age, sex ratio, hypothyroidism The frequency in the study sample. 路 To see which hormones are the largest proportion of the overall endocrine deficit of the post-operative patient, and to help take the necessary measures to further develop the patient in the future Management to minimize its impact. Review of growth hormone in the cranium of the adult opharyngioma In our research results. Methods and materials (i) Study Population/ Inclusion Criteria: Age:18 years of operation Type: overall total resection of the tumor. Method of operation: amount Lateral approach single person Operation to reduce surgeon's surgical technique bias. (ii) Study design: at the ring-lake hospital,2008- 34 adult patients with surgical treatment in 2013 A retrospective study of the medical records. The reference value of the study is according to the ring lake hospital laboratory . T3:1.3-3.1nmol/ L T4:66-181nmol /L TSH:0.27-4. 2 UIU/ ml GH: 0.06 -5.0 ng/ ml PRL: 2.5-17 ng/ ml LH:0. 8-7.6 MIU/ ml ADH: 2.2 -14pg/ ml Corticotropin:0-46 pg/ ml COR:5-25 ug/ L FSH : 0.7-11.7 mIU/ L data with statistical software package social science (SPSS software Version 17.0) for statistical analysis Analysis. The statistical significance of the Wilcoxon signed-rank test was assessed using a non-parametric 2-dependent sample test (Wilcoxon signed-rank test). The data is the test standard at 0.05. Result 1. Average The mean age and the standard deviation of the patient were (47.11-1.2) years, with an average of 50 years.2. The proportion of women to men was 1: 1.3. The pre-operative and post-operative hormone levels of thyroid hormones were as follows: the plasma average of T3, T4, and TSH before operation was 2.41 nmol/ L, 48.99 nm, respectively. The thyroid hormone levels were 1.73 nmol/ L, 23.47 nmol/ L and 0.16 UIU/ ml, respectively. The LH plasma average was 3.35 MIU/ ml and 1.78 MIU/ ml, respectively, and the prolactin was 24.04 ng/ mL and 18.59 ng/ ml, respectively. The adrenocortical hormone and the growth hormone were 0.372 ng/ ml and 0.34 ng/ ml, and the adrenocortical hormone was 15.81 ug/ ml and 8.30 ug/ ml, respectively, and the FSH was 8.94 MIU/ L, respectively. and 4.87 MIU/ L. 5.T3. T4. TS The mean plasma values before and after the H. GRH. FSH. LH procedure were significantly different, and the PRL There was no significant difference in the mean value of the hormone before and after operation. The pre-operative endocrine disease was common in the patients with craniopharyngioma. The clinical feature may not be a very clear and detailed procedure The pre-operative endocrine assessment is essential. Failure to recognize and address pre-operative diabetes insipidus and in that course of any surgical treatment, A further deterioration in the secretion of secretion. Studies have shown that the decline in hormone dysfunction The trend. It's easy to predict this trend, but it's essential to know the pattern of hormones. Not all of the hormones are down. We have studied a single hormone to get the pre-and post-operative proportions of each hormone. Thyroid function and thyroid stimulating hormone: we The study of thyroid hormone and the previous literature were different; the overall incidence of hypothyroidism was 6 before and after operation 1% and 73.5% (P0.01). Honeger et al. reported that the function of hypothyroidism The incidence of pre-and post-operative morbidity was 24.5% and 38.5%, respectively. Our study was much lower. The results were measured three months after the operation of T3 and T4, but our results were measured one week after the operation. The interval between the two studies may help to explain them. The difference was that the incidence of hypothyroidism in the other study was 70% before and after the operation, respectively. 95%, higher than our study, this study shows that thyroxine should be taken in all of the patients with craniopharyngioma. Our results show that T SH is the most common type of hormone deficiency, and the LH hormone deficiency is followed. The thyroid gland hormone is the most common hormone insufficiency, and can be seen before operation. 21 of 34 patients; postoperative visual Of the 34 patients,25 of the 34 patients. LH hormone dysfunction was found in 22 pre-operative and The proportion of PRL and LH in 18 patients was decreased after operation. Assessment It is necessary. Therefore, it is recognized that each patient is individually excited The tendency to reduce the function of the hormone is very important. The hormone axis and disease The anatomy of the disease and the complexity of the treatment process require further in-depth enlargement of the sample's forward-looking Sex study. Conclusion: The lack of hormone appears to be a common complication of the operation. The occurrence of R and LH hormone deficiency is more frequent.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.41
本文编号：2505016
[Abstract]:In this paper, the age, sex distribution, recurrence pattern and hormonal changes of the patients were briefly summarized. The previous report focused on the patient's symptoms and ignored the actual ratio, and our study focused more on the patient's hormone fluctuation and the endocrine disease. Long-term follow-up and complications are challenging, despite the low level of histology. Clinical symptoms include an important structure of a tumor that is secondary to intracranial pressure, hydrocephalus, or compression of the central nervous system, resulting in headache, nausea, blurred vision, and polyuria and thirst, secondary to intracranial pressure increase, hydrocephalus, or compression of the central nervous system. It is well known that craniopharyngioma usually results in an abnormal endocrine disorder due to the close relationship between its origin and the hypothalamus. The destruction of the hypothalamic structure and the treatment of various endocrine disorders, in turn, have a shadow on the quality of life of the patient due to the tumor's destruction of the hypothalamic structure and the treatment In response, most patients (85-95%) suffer from a variety of hypothalamic-pituitary functional deficiencies, including the completion of the pituitary function, and the lack of a full recovery of the hormone prior to the procedure occurs only in rare cases where growth hormone replacement therapy is a proven problem for the treatment of growth hormone deficiency effective and safe treatment party Cases. However, the disruption of the hypothalamic structure and the disorder in the treatment of the tumor are considered to be the main cause of the main cause of the gluttony and obesity, and the extent and the sequelae of the hypothalamic injury are assessed by the imaging Assessment of endocrine and metabolic disorders in the follow-up process, regardless of initial surgical treatment and surgery and/ or radiation therapy The absence of a full recovery of the hormone prior to the operation occurs only in a very small number of cases The patient's age relationship was unknown by univariate analysis, neurological, vascular and visual complications, and postoperative endocrine changes in the patient. In order to reduce the effect of the endocrine on the patient, the endocrine condition of the patient line-and-study The purpose of this study was to analyze the pituitary of the patients with craniopharyngioma before and after operation. Changes of the previous leaf hormone. 路 observed mean age, sex ratio, hypothyroidism The frequency in the study sample. 路 To see which hormones are the largest proportion of the overall endocrine deficit of the post-operative patient, and to help take the necessary measures to further develop the patient in the future Management to minimize its impact. Review of growth hormone in the cranium of the adult opharyngioma In our research results. Methods and materials (i) Study Population/ Inclusion Criteria: Age:18 years of operation Type: overall total resection of the tumor. Method of operation: amount Lateral approach single person Operation to reduce surgeon's surgical technique bias. (ii) Study design: at the ring-lake hospital,2008- 34 adult patients with surgical treatment in 2013 A retrospective study of the medical records. The reference value of the study is according to the ring lake hospital laboratory . T3:1.3-3.1nmol/ L T4:66-181nmol /L TSH:0.27-4. 2 UIU/ ml GH: 0.06 -5.0 ng/ ml PRL: 2.5-17 ng/ ml LH:0. 8-7.6 MIU/ ml ADH: 2.2 -14pg/ ml Corticotropin:0-46 pg/ ml COR:5-25 ug/ L FSH : 0.7-11.7 mIU/ L data with statistical software package social science (SPSS software Version 17.0) for statistical analysis Analysis. The statistical significance of the Wilcoxon signed-rank test was assessed using a non-parametric 2-dependent sample test (Wilcoxon signed-rank test). The data is the test standard at 0.05. Result 1. Average The mean age and the standard deviation of the patient were (47.11-1.2) years, with an average of 50 years.2. The proportion of women to men was 1: 1.3. The pre-operative and post-operative hormone levels of thyroid hormones were as follows: the plasma average of T3, T4, and TSH before operation was 2.41 nmol/ L, 48.99 nm, respectively. The thyroid hormone levels were 1.73 nmol/ L, 23.47 nmol/ L and 0.16 UIU/ ml, respectively. The LH plasma average was 3.35 MIU/ ml and 1.78 MIU/ ml, respectively, and the prolactin was 24.04 ng/ mL and 18.59 ng/ ml, respectively. The adrenocortical hormone and the growth hormone were 0.372 ng/ ml and 0.34 ng/ ml, and the adrenocortical hormone was 15.81 ug/ ml and 8.30 ug/ ml, respectively, and the FSH was 8.94 MIU/ L, respectively. and 4.87 MIU/ L. 5.T3. T4. TS The mean plasma values before and after the H. GRH. FSH. LH procedure were significantly different, and the PRL There was no significant difference in the mean value of the hormone before and after operation. The pre-operative endocrine disease was common in the patients with craniopharyngioma. The clinical feature may not be a very clear and detailed procedure The pre-operative endocrine assessment is essential. Failure to recognize and address pre-operative diabetes insipidus and in that course of any surgical treatment, A further deterioration in the secretion of secretion. Studies have shown that the decline in hormone dysfunction The trend. It's easy to predict this trend, but it's essential to know the pattern of hormones. Not all of the hormones are down. We have studied a single hormone to get the pre-and post-operative proportions of each hormone. Thyroid function and thyroid stimulating hormone: we The study of thyroid hormone and the previous literature were different; the overall incidence of hypothyroidism was 6 before and after operation 1% and 73.5% (P0.01). Honeger et al. reported that the function of hypothyroidism The incidence of pre-and post-operative morbidity was 24.5% and 38.5%, respectively. Our study was much lower. The results were measured three months after the operation of T3 and T4, but our results were measured one week after the operation. The interval between the two studies may help to explain them. The difference was that the incidence of hypothyroidism in the other study was 70% before and after the operation, respectively. 95%, higher than our study, this study shows that thyroxine should be taken in all of the patients with craniopharyngioma. Our results show that T SH is the most common type of hormone deficiency, and the LH hormone deficiency is followed. The thyroid gland hormone is the most common hormone insufficiency, and can be seen before operation. 21 of 34 patients; postoperative visual Of the 34 patients,25 of the 34 patients. LH hormone dysfunction was found in 22 pre-operative and The proportion of PRL and LH in 18 patients was decreased after operation. Assessment It is necessary. Therefore, it is recognized that each patient is individually excited The tendency to reduce the function of the hormone is very important. The hormone axis and disease The anatomy of the disease and the complexity of the treatment process require further in-depth enlargement of the sample's forward-looking Sex study. Conclusion: The lack of hormone appears to be a common complication of the operation. The occurrence of R and LH hormone deficiency is more frequent.
【学位授予单位】：天津医科大学
【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2条
1 ;Microsurgical treatment of craniopharyngiomas:report of 284 patients[J];Chinese Medical Journal;2006年19期
2 周忠清,石祥恩;Changes of hypothalamus-pituitary hormones in patients after totalr emoval of craniopharyngiomas[J];Chinese Medical Journal;2004年03期
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