手术和伽马刀治疗垂体生长激素腺瘤激素水平变化分析

发布时间：2019-03-08 12:51

【摘要】：目的探讨垂体生长激素腺瘤手术治疗和伽马刀治疗前后生长激素水平变化情况。方法收集2011年06月至2015年01月在郑州大学第一附属医院神经外科进行首次诊治的95例垂体生长激素腺瘤患者的完整病例资料。单纯行手术治疗的为手术组,共61例,结合术中情况及术后影像资料等,进一步分为手术全切组(45例)和未全切组(16例),单纯行伽马刀治疗的为伽马刀组(OUR-XGD旋转式伽马刀),共34例。结合临床症状、内分泌和影像学检查,所有病例均诊断为垂体生长激素腺瘤。随访12个月,比较各组治疗前后不同时间点生长激素水平变化情况。结果手术全切组和未全切组术后1周生长激素水平均较术前明显下降,差异明显(p0.01),术后1周生长激素水平与术后1月、3月、6月、12月均无明显差异,无统计学意义(p0.05)。手术全切组术后1周、1月、3月、6月、12月激素水平下降程度均较未全切组明显,差异明显(p0.01)。伽马刀组治疗后1月、3月生长激素水平较治疗前均无明显差异,无统计学意义(p0.05),治疗后6月生长激素水平较治疗前下降,有统计学意义(p0.05),治疗后12月生长激素水平较治疗后6月下降,差异明显(p0.01);伽马刀组治疗后12月生长激素水平下降程度低于手术全切组和未全切组,差异有统计学意义(p0.05)。结论1、手术治疗可以快速改善生长激素腺瘤患者术前高激素水平状态,手术治疗效果肯定,是首选治疗方法;术后1周生长激素水平可以作为判断手术疗效的指标。肿瘤全切患者术后激素水平改善更明显,应在不增加正常垂体损害的前提下争取全切肿瘤。2、伽马刀治疗后生长激素水平下降缓慢,不能快速改善患者高激素水平状态,随着时间的延长生长激素水平逐渐下降。1年内伽马刀治疗对生长激素水平的改善较手术治疗差。
[Abstract]:Objective to investigate the changes of growth hormone level before and after surgical treatment of pituitary growth hormone adenoma and gamma knife therapy. Methods from June 2011 to January 2015, 95 patients with pituitary growth hormone adenoma were first diagnosed and treated in the Neurosurgery Department of the first affiliated Hospital of Zhengzhou University. 61 cases were treated by operation alone. Combined with intraoperative conditions and postoperative imaging data, they were further divided into two groups: total resection group (45 cases) and non-complete resection group (16 cases), and the patients were divided into two groups: total resection group (n = 45) and incomplete group (n = 16). 34 cases of gamma knife group (OUR-XGD rotating gamma knife) were treated with gamma knife alone. Combined with clinical symptoms, endocrine and imaging examination, all cases were diagnosed as pituitary growth hormone adenoma. After 12 months of follow-up, the levels of growth hormone in each group were compared at different time points before and after treatment. Results the levels of growth hormone at 1 week after operation in total resection group and non-complete resection group were significantly lower than those before operation (p0.01). There was no significant difference in growth hormone level between 1 week and 1 month, 3 months, 6 months and 12 months after operation, and there was no significant difference in the level of growth hormone between the two groups. There was no statistical significance (p0.05). 1 week, 1 month, 3 months, 6 months and 12 months after operation, the levels of hormone in the total resection group were significantly lower than those in the non-complete resection group (p0.01). There was no significant difference in growth hormone level at 1 month and 3 months after treatment in the gamma knife group compared with that before treatment (p0.05). 6 months after the treatment, the growth hormone level decreased significantly (p0.05), and the growth hormone level in the gamma knife group was significantly lower than that before treatment (p0.05). The level of growth hormone in 12 months after treatment was significantly lower than that in 6 months after treatment (p0.01). The level of growth hormone in the gamma knife group was significantly lower than that in the total resection group and the non complete resection group after 12 months of treatment (p0.05). Conclusions 1. Surgical treatment can rapidly improve the state of high hormone level in patients with growth hormone adenoma before operation, which is the first choice for surgical treatment, and the level of growth hormone at one week after operation can be used as an index to judge the curative effect of surgery. 2. The improvement of hormone level after total resection of tumor is more obvious, and we should strive for total removal of tumor without increasing normal pituitary damage. 2. After gamma knife treatment, the level of growth hormone decreases slowly, and can not improve the state of high hormone level in patients rapidly. The level of growth hormone decreased gradually with the prolongation of time, and the improvement of growth hormone level of gamma knife therapy was worse than that of surgical treatment within 1 year.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R736.4

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