200例垂体腺瘤患者的临床特征及治疗回顾

发布时间：2019-01-06 15:48

【摘要】：目的：回顾200例垂体腺瘤患者年龄、性别以及手术方式等临床资料,探讨垂体腺瘤的临床特征、诊断及外科治疗,以此为基础逐步积累本地区垂体腺瘤的经验,随时调整治疗策略,达到更满意的治疗效果。方法：收集2012年9月～2014年9月昆明医科大学附属第一医院神经外科200例病例进行回顾分析,所有入选病例均经术后病理检查明确为垂体腺瘤。统计资料内容包括有一般资料、临床表现、内分泌检查结果、影像学检查结果、病理学检查结果、手术入路选择、术后并发症以及处理等。结果：200例患者中男性93例,女性107例,年龄分布18岁～72岁,以20～50居多。就诊症状主要包括视力视野受损、头痛头晕、闭经、泌乳等,另外有少数肢端肥大体形、向心性肥胖者,病程1月至10年不等。病理类型以多激素细胞性腺瘤(26.5%)和泌乳素激素细胞性腺瘤(25.5%)最多。初步诊断依靠CT或MRI所见。200例患者中,184例患者行“单鼻孔经蝶垂体瘤切除术”,95例术前视力及视野障碍者,术后改善者82例,发生术后并发症107例；其他16例患者行“经颅垂体瘤切除术”,术前10例有视力及视野障碍,术后改善者5例,发生术后并发症14例。外科手术后症状缓解率为91.5%,治愈率为85.5%,复发率为4.0%,死亡率0.5%。结论：1.我院所处区域女性垂体腺瘤患者多于男性,20～50岁的患者发病率较高。患者入院主要的临床首发症状为头昏头痛、视力下降和视野缺损,其余为内分泌异常,男性患者主要为性功能减退,女性患者为闭经和泌乳。2.术后病理资料显示病理类型以多激素分泌型腺瘤和泌乳素腺瘤居多。除泌乳素细胞性瘤女性的发病率明显高于男性外,其他各型垂体瘤并无明显性别差异。3.经统计学证实,患者临床症状的改善以及并发症的发生与手术方式有明显相关性。经鼻蝶入路手术相对经颅手术来说,具有损伤小、手术时间短、并发症少、术后康复时间短、手术死亡率极低等优点,可作为绝大多数垂体腺瘤患者的首选治疗方法
[Abstract]:Objective: to review the clinical data of 200 patients with pituitary adenoma, including age, sex and surgical methods, and to explore the clinical features, diagnosis and surgical treatment of pituitary adenomas, and to gradually accumulate the experience of pituitary adenomas in our region. Adjust the treatment strategy at any time to achieve a more satisfactory therapeutic effect. Methods: from September 2012 to September 2014, 200 cases of neurosurgery in the first affiliated Hospital of Kunming Medical University were retrospectively analyzed. Statistical data include general data, clinical manifestations, endocrine findings, imaging findings, pathological findings, surgical approach options, postoperative complications and management. Results: among the 200 patients, 93 were male and 107 were female. The age distribution ranged from 18 to 72 years old. The symptoms included visual field impairment, headache and dizziness, amenorrhea, lactation, and a few patients with hypertrophy and obesity. The course of disease ranged from 1 month to 10 years. The most common pathological types were polyhormone cell adenoma (26. 5%) and prolactin cell adenoma (25. 5%). Among the patients who were diagnosed by CT or MRI, 184 patients were treated with single nostril transsphenoidal pituitary adenoma resection, 95 patients with visual acuity and visual field disorder before operation, 82 patients with postoperative improvement and 107 patients with postoperative complications. The other 16 patients underwent "transcranial pituitary adenectomy". 10 cases had visual acuity and visual field disorder before operation, 5 cases were improved after operation, and 14 cases had postoperative complications. The remission rate of symptoms was 91.5%, the cure rate was 85.5%, the recurrence rate was 4.0%, and the mortality was 0.5%. Conclusion: 1. The incidence of pituitary adenoma in female patients was higher than that in male patients aged 20 ~ 50 years. The main clinical symptoms of the patients were dizziness headache, vision loss and visual field defect, the rest were endocrine abnormalities, the male patients were mainly sexual dysfunction, and the female patients were amenorrhea and lactation. 2. Postoperative pathological data showed that polyhormone secreted adenoma and prolactin adenoma were the main pathological types. Except for the incidence of prolactinomyoma in women was significantly higher than that in men, there was no significant gender difference in other types of pituitary adenomas. Statistically, the improvement of clinical symptoms and the occurrence of complications were significantly correlated with the operative methods. Compared with transcranial surgery, transsphenoidal approach has the advantages of less injury, shorter operative time, less complications, shorter postoperative recovery time and lower operative mortality. It can be used as the first choice for most pituitary adenoma patients.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R736.4

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