428例住院垂体瘤患者的临床资料分析

发布时间：2018-09-10 13:24

【摘要】：目的:1.分析近3年我院住院垂体瘤患者的临床发病特点。2.评估术前临床诊断与术后病理免疫组化染色诊断的一致性。3.提高对垂体瘤的发病认识并指导治疗。方法:1.通过青岛大学附属医院HIS系统收集2013年1月-2016年4月于我院神经外科、内分泌科的住院垂体腺瘤患者,对其病历资料进行整理、录入Excel表格:包括姓名、性别、年龄、首发症状、临床症状、影像学表现、手术方式、垂体激素水平、术后病理免疫组化染色结果、并发症、术后用药等。2.分析患者年龄、性别、首发症状、临床表现、影像学表现、手术方式、术后并发症及预后的特征。3.比较患者术前临床诊断与术后病理免疫组化诊断的一致性,运用SPSS21.0统计软件进行统计分析,P0.05认为有统计学意义。结果:1.分类:垂体瘤428例,包括PRL瘤54例、GH瘤38例、FSH/LH瘤138例、ACTH瘤11例、TSH瘤1例、多激素腺瘤52例、无功能腺瘤105例、未知功能瘤29例,女性(246例,57.5%)多于男性(182例,42.5%)。2.临床特征:平均发病年龄(50.2±12.5)岁,40~60岁多发(240例,56.1%);垂体瘤压迫症状常见有头晕头痛(245例,57.2%)、视力视野改变(285例,66.6%)等,内分泌症状常见有女性月经异常(66例,26.8%)、肢端肥大症(62例,14.5%)、溢乳(18例,4.2%)、性功能下降(17例,4.0%)等,患者以压迫症状首发的占75%,以内分泌症状首发的占20%,其中女性PRL瘤以闭经溢乳首发多(65.5%)、GH瘤以肢端肥大症首发多(65.8%)。3.影像学特点:完善MRI/CT检查的患者417例(97.4%),大腺瘤占比例高(354例,86.1%),PRL瘤中男性发生大腺瘤的比例高于女性(t=3.571,P0.05),视力视野改变与视交叉受压的相符率为66.4%。4.手术方式与术后治疗:手术治疗407例(95.1%),手术方式以经鼻蝶入路为主(86.0%),大腺瘤手术并发症发生率高于微腺瘤,术后使用肾上腺皮质激素(75%)、甲状腺激素(41.6%)替代治疗患者多。5.术前临床诊断与病理免疫组化染色诊断的一致性:PRL瘤、GH瘤术前临床诊断与术后病理诊断一致性较好(PRL瘤Kappa系数0.707,GH瘤Kappa系数0.754);ACTH瘤术前临床诊断与术后病理诊断一致性较差(Kappa系数0.376),血清ACTH水平升高(ACTH60pg/ml)与术后病理诊断有较好相关性(P0.05);男性FSH瘤中FSH升高(FSH15 IU/L)与术后病理诊断无明显相关性(P0.05)。结论:住院垂体瘤患者中以病理诊断的无功能瘤、FSH/LH瘤最多见;大腺瘤发病率高;垂体瘤临床表现多样化,压迫症状发生率最高,PRL瘤、GH瘤多以内分泌症状首发;垂体瘤手术方式以经鼻蝶入路内镜下为主,多数患者需术后行激素替代治疗;PRL瘤、GH瘤术前临床诊断与术后病理免疫组化染色诊断一致性好,血清PRL、GH、ACTH水平升高对临床诊断有较大指导意义;垂体瘤诊断需依靠临床表现、内分泌学、影像学检查及病理免疫组织化学染色检查的综合判断,早期正确诊断对患者选择最佳治疗方案、获得最佳预后有重要意义。
[Abstract]:Purpose 1. To analyze the clinical characteristics of pituitary adenoma in our hospital in recent 3 years. To evaluate the consistency between preoperative clinical diagnosis and postoperative pathological immunohistochemical diagnosis. 3. 3. To improve the understanding of pituitary adenoma and guide the treatment. Method 1: 1. From January 2013 to April 2016, patients with pituitary adenoma in neurosurgery and endocrine department of our hospital were collected by HIS system of affiliated Hospital of Qingdao University. Their medical records were collected and recorded in Excel form: name, sex, age, etc. Initial symptoms, clinical symptoms, imaging manifestations, operative methods, pituitary hormone levels, postoperative pathological immunohistochemical staining results, complications, postoperative medication, etc. Analysis of age, sex, initial symptoms, clinical manifestations, imaging manifestations, surgical methods, postoperative complications and prognosis. To compare the consistency between preoperative clinical diagnosis and postoperative pathological immunohistochemical diagnosis, SPSS21.0 statistical software was used to carry out statistical analysis (P0.05) that there was statistical significance. The result is 1: 1. Classification: there were 428 cases of pituitary adenoma, including 54 cases of PRL tumor, 38 cases of GH tumor and 38 cases of FSH / LH tumor. There were 1 case of ACTH tumor, 52 cases of polyhormone adenoma, 105 cases of nonfunctional adenoma, 29 cases of unknown function tumor. Women (246 cases, 57.5%) were more than men (42. 5%, 42. 5%). Clinical features: the average age of onset was (50.2 卤12.5) years old or more than 4060 years old (240 cases, 56.1%), the common symptoms of pituitary adenoma compression were dizziness and headache (245 cases, 57.2%), visual field changes (285 cases, 66.6%), and so on. The common endocrine symptoms were abnormal menstruation (66 cases, 26.8%), acromegaly (62 cases, 14.5%), galactorrhea (18 cases, 4.2%), sexual dysfunction (17 cases, 4.0%), etc. 75 patients were diagnosed with compression symptoms and 20 with endocrine symptoms. Among them, the most of female PRL tumors were amenorrhea galactorrhea (65.5%) and GH tumors with acromegaly (65.8%) .3. Imaging features: 417 cases (97.4%) were improved MRI/CT examination, and the proportion of macroadenoma was high (354 cases, 86.1%). The incidence of macroadenoma in male was higher than that in female (t = 3.571P 0.05). The coincidence rate between visual field change and cross optic compression was 66.4%. Operation and postoperative treatment: 407 cases (95.1%) were treated surgically. Transsphenoidal approach was the main method (86.0%). The incidence of complications in macroadenoma was higher than that in microadenoma. After operation, adrenocortical hormone (75%) and thyroid hormone (41.6%) were used in replacement therapy. The consistency between preoperative clinical diagnosis and pathological immunohistochemical diagnosis of GH tumor is good (Kappa coefficient of PRL tumor is 0.707 and Kappa coefficient of GH tumor is 0.754); preoperative clinical diagnosis of PRL tumor is consistent with postoperative pathological diagnosis. There was no significant correlation between the increase of serum ACTH (ACTH60pg/ml) and postoperative pathological diagnosis (P0.05), and the increase of FSH (FSH15 IU/L) in male FSH tumor was not correlated with postoperative pathological diagnosis (P0.05). Conclusion: in the hospitalized patients with pituitary adenoma, the most nonfunctional FSH / LH tumor was diagnosed by pathology, the incidence of macroadenoma was high, the clinical manifestation of pituitary adenoma was diversified, and the incidence of compression symptom was the highest. Transsphenoidal endoscopy was the main operative method for pituitary adenoma. Most of the patients needed hormone replacement therapy. The preoperative clinical diagnosis of PRL tumor was consistent with the pathological immunohistochemical staining. The clinical diagnosis of pituitary adenoma depends on the comprehensive judgement of clinical manifestation, endocrinology, imaging examination and pathological immunohistochemical staining. Early correct diagnosis is important for patients to choose the best treatment plan and obtain the best prognosis.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.4

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