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目的回顾分析垂体Cushing病经蝶手术治疗的疗效,探讨其手术技巧及影响疗效的因素。方法回顾2001年1月至2006年12月间经蝶手术的垂体Cushing病54例,其中微腺瘤39例,大腺瘤3例,核磁共振未见肿瘤征象者12例(通过地塞米松抑制试验和/或岩下窦采血证实为垂体Cushing病),术中行选择性腺瘤切除者38例,部分或半垂体切除者16例,术后病理证实为ACTH腺瘤者49例,垂体ACTH细胞增生者5例;术后缓解标准为术后第1d或第2d患者的血皮质醇≤5μg/L。结果本组病人的缓解率75.9%,术前磁共振可显示肿瘤的患者缓解率(36/42,85.7%)高于未见肿瘤者(5/12,P<0.05),术中选择性腺瘤切除患者的缓解率(32/38,84.2%),亦高于其他(P<0.05),同样,术后病理证实为腺瘤的高于增生者(P<0.05);随访期内复发2例。结论只要内分泌检查提示垂体Cushing病,即使磁共振未见肿瘤征象,也可行经蝶手术探查;从术前影像学表现、术中以及术后病理是否证实ACTH腺瘤可预测疗效。
Objective To retrospectively analyze the curative effect of transsphenoidal pituitary surgery for pituitary tumors and to explore the surgical techniques and the factors that affect curative effect. Methods From January 2001 to December 2006, 54 cases of pituitary tumor were treated by transsphenoidal surgery, including 39 cases of microadenomas, 3 cases of large adenomas, 12 cases of tumors without nuclear magnetic resonance (inhibition by dexamethasone 38 cases of selective adenoma resection, partial or semi-pituitary resection in 16 cases, postoperative pathology confirmed as ACTH adenoma in 49 cases, pituitary ACTH cell hyperplasia 5 cases. The standard of postoperative relief was blood cortisol ≤5μg / L on the first or second postoperative day. Results The response rate of patients in this group was 75.9%. The preoperative MRI showed that the remission rate was higher in patients with tumor (36 / 42.59%) than in those without tumor (5/12, P <0.05) (32/38, 84.2%) were also higher than those in the other patients (P <0.05). Similarly, postoperative pathology was confirmed as adenoma in hyperplasia (P <0.05). In the follow-up period, 2 patients relapsed . Conclusion As long as the endocrine examination suggests that the pathogen of the pituitary ght disease, even if the MRI showed no signs of tumor, transsphenoidal surgery is also feasible. From the preoperative imaging findings, intraoperative and postoperative pathology whether ACTH adenoma predicts efficacy.