残留或复发的生长激素型垂体腺瘤手术再治疗的预后分析

发布时间：2018-02-23 13:06

  本文关键词： 生长激素型垂体腺瘤 GH IGF-1 TSS 复发 残留 肢端肥大症　出处：《北京协和医学院》2015年博士论文　论文类型：学位论文

【摘要】：目的建立生长激素型垂体腺瘤数据库,整合患者的所有临床资料为科研提供数据基础。从数据库中选出符合要求的病例资料进行分析。本研究旨在分析2012年初-2015年初通过TSS再次治疗的患者的预后相关因素,评估TSS再次治疗的意义。方法和软件公司协作建立生长激素型垂体腺瘤数据库,录入2012年以来在北京协和医院就诊的生长激素型垂体腺瘤患者的临床资料,并对部分可能在科研中用到的描述性指标进行人工识别和录入。从数据库中查询2012年初-2014年初在本院接受治疗的垂体腺瘤患者病历资料,满足由同一组经验丰富的大夫给予经鼻蝶窦入路垂体腺瘤切除术治疗、病历资料完整、有随访记录的患者共101例,其中初治患者81例(80.2%),经治患者20例(19.8%)。将经治组患者按照是否治愈分成两组,然后对组间性别、发病年龄、病程、肿瘤大小、激素水平、侵袭性等临床因素进行回顾性分析。然后将初治组和经治组分别按照是否侵袭生长进行分组,对组间预后差异进行分析评估手术再治疗的意义。结果患者性别、发病年龄、术前GH/IGF-1水平、肿瘤大小、肿瘤纤维化程度、术前是否使用善龙均与TSS再次治疗的预后无明显相关性,而肿瘤的侵袭性则在治愈与未治愈组间表现出显著差异。初治组和采用TSS作为再次治疗手段的经治组间总体治愈率和并发症的出现无明显差异。侵袭性肿瘤患者再次手术治疗出现尿崩并发症的机会显著高于初治患者。结论TSS再治疗可以有效地降低患者的GH水平,虽然治愈率较初次治疗有下降趋势,但是对于改善患者的生存率、生活质量、术后辅助治疗的疗效都有重要意义。TSS再治疗是比较安全的,仅在侵袭性腺瘤中出现尿崩的机会显著增加,在非侵袭性腺瘤中预后更好。
[Abstract]:Objective to establish a growth hormone pituitary adenoma database. All the clinical data of the patients were integrated to provide a data basis for scientific research. The patients who met the requirements were selected from the database for analysis. The purpose of this study was to analyze the prognostic factors of the patients who were re-treated with TSS from early 2012 to early 2015. Methods to establish a growth hormone pituitary adenoma database in collaboration with software company, and to record the clinical data of growth hormone type pituitary adenoma patients who had been treated in Peking Union Hospital since 2012. And some of the descriptive indicators that may be used in scientific research are manually identified and input. The medical records of pituitary adenoma patients who were treated in our hospital from early 2012 to early 2014 were consulted from the database. One group of experienced doctors were treated by transsphenoidal approach for pituitary adenoma resection. 101 patients were treated with complete medical records and follow-up records, and 101 patients were treated by transsphenoidal transsphenoidal approach. Among them, 81 cases of newly treated patients and 20 cases of treated patients were divided into two groups according to whether they were cured or not, and then the sex, age, course of disease, tumor size, hormone level of the treated group were analyzed. The invasive clinical factors were analyzed retrospectively. Then the primary treatment group and the meridian treatment group were divided into groups according to the invasion and growth, and the significance of surgical retreatment was evaluated by analyzing the difference of prognosis between the groups. There was no significant correlation between preoperative GH/IGF-1 level, tumor size, degree of tumor fibrosis and the prognosis of TSS retreatment. However, the invasiveness of tumor showed significant difference between cured and uncured groups. There was no significant difference in the overall cure rate and complications between the primary treatment group and the treated group using TSS as the retreatment method, and there was no significant difference in the occurrence of complications in the invasive tumor patients. The chance of complications of urethral avalanche in reoperation was significantly higher than that in the first treatment. Conclusion TSS retreatment can effectively reduce the GH level of the patients. Although the cure rate is decreasing compared with the initial treatment, it is safe to improve the survival rate, the quality of life and the curative effect of postoperative adjuvant therapy. Only in invasive adenomas, the incidence of urinary collapse was significantly increased, and the prognosis was better in noninvasive adenomas.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R736.4
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本文编号：1526704