库欣病的经蝶窦手术：82例患者的内分泌随访监测

Transsphenoidal surgery for Cushing's disease: endocrinological follow-up monitoring of 82 patients.

作者信息

Shimon Ilan, Ram Zvi, Cohen Zvi R, Hadani Moshe

机构信息

Institute of Endocrinology, Chaim Sheba Medical Center, Tel Hashomer, Israel.

出版信息

Neurosurgery. 2002 Jul;51(1):57-61; discussion 61-2. doi: 10.1097/00006123-200207000-00008.

DOI:10.1097/00006123-200207000-00008

PMID:12182435

Abstract

OBJECTIVE

Transsphenoidal surgery is the preferred treatment modality for adrenocorticotropic hormone-secreting pituitary adenomas. In the past 2 decades, several institutions in the United States and Europe have reported remission rates of 70 to 85% after transsphenoidal surgery for treatment of Cushing's disease. We analyzed our postoperative results for a large cohort of patients with Cushing's disease.

METHODS

Eighty-two patients with adrenocorticotropic hormone-secreting adenomas (79 microadenomas and 3 macroadenomas) underwent transsphenoidal surgery between 1990 and 2000. Seventy-seven patients were surgically treated for the first time, and 13 patients underwent reoperations (5 had undergone the first operation elsewhere) because of previous surgical failure (10 patients) or recurrence (3 patients). The mean postoperative follow-up period was 4.2 +/- 2.8 years. Biochemical remission was defined as postoperative normalization of elevated 24-hour urinary free cortisol secretion and suppression of morning cortisol levels with 1 mg of dexamethasone.

RESULTS

Remission was achieved for 78% of all patients after one operation and for 62% of patients who underwent a second operation. The recurrence rate was 5%. Ten patients did not exhibit a visible tumor on magnetic resonance imaging scans, and the other patients were divided according to adenoma size (2-5 or 6-10 mm). Remission rates were similar for the three groups of patients (78-80%). Pituitary tumor stained for adrenocorticotropic hormone was detected in 78% of resected pituitary tissue specimens obtained from patients who achieved remission, compared with 53% from patients who experienced surgical failure (P = 0.06).

CONCLUSION

Our series demonstrates the efficacy of transsphenoidal surgery for Cushing's disease resulting from pituitary microadenomas. Microadenoma size had no effect on the remission rate. Reoperations are indicated after initial surgical failures.

摘要

目的

经蝶窦手术是促肾上腺皮质激素分泌型垂体腺瘤的首选治疗方式。在过去20年里，美国和欧洲的多家机构报告称，经蝶窦手术治疗库欣病后的缓解率为70%至85%。我们分析了大量库欣病患者的术后结果。

方法

1990年至2000年间，82例促肾上腺皮质激素分泌型腺瘤患者（79例微腺瘤和3例大腺瘤）接受了经蝶窦手术。77例患者首次接受手术治疗，13例患者因先前手术失败（10例患者）或复发（3例患者）而接受再次手术（5例患者曾在其他地方接受过首次手术）。术后平均随访期为4.2±2.8年。生化缓解定义为术后24小时尿游离皮质醇分泌升高恢复正常，且1毫克地塞米松可抑制晨皮质醇水平。

结果

所有患者一次手术后的缓解率为78%，接受二次手术的患者缓解率为62%。复发率为5%。10例患者在磁共振成像扫描中未发现可见肿瘤，其他患者根据腺瘤大小（2 - 5或6 - 10毫米）进行分组。三组患者的缓解率相似（78 - 80%）。在缓解患者的切除垂体组织标本中，78%检测到促肾上腺皮质激素染色的垂体肿瘤，而手术失败患者的这一比例为53%（P = 0.06）。