Esposito V, Santoro A, Minniti G, Salvati M, Innocenzi G, Lanzetta G, Cantore G
Department of Neurological Sciences, IRCCS-NEUROMED, University of Rome La Sapienza, Parco Tecnologico, Via Atinense, I-86077 Pozzilli (IS), Italy.
Neurol Sci. 2004 Dec;25(5):251-6. doi: 10.1007/s10072-004-0351-z.
Transsphenoidal surgery (TSS) is a well recognised treatment for secreting pituitary adenomas, however a very wide variation of clinical outcomes and recurrence rates has been reported, depending on the different criteria used to define the cure. We reported the clinical outcome of a large series of patients operated on for a secreting pituitary adenoma according to the most recent stringent criteria of biochemical remission nowadays accepted. One hundred and twenty-five consecutive patients with a secreting pituitary adenoma (42 PRL-, 67 GH- and 16 ACTH-secreting adenomas) who were operated on by the two same neurosurgeons were considered for the study. Biochemical remission of disease was achieved in 56% of patients; 78% for patients with microadenoma and 47% for patients with macroadenomas, respectively. No cases of mortality or major immediate postoperative complications were observed. Tumour size, high hormone levels and dural invasion were significantly correlated to a poor surgical outcome. The recurrence rates ranged between 0 and 24%, being higher for PRL-secreting tumours. In conclusion, TSS is safe and effective in secreting pituitary tumours. It is still the first treatment for GH- and ACTH-secreting adenomas, whereas in patients with prolactinomas, surgery should be reserved for cases of resistance or intolerance to dopamine agonists.
经蝶窦手术（TSS）是公认的分泌性垂体腺瘤的治疗方法，然而，根据用于定义治愈的不同标准，临床结果和复发率的差异很大。我们根据目前公认的最新严格生化缓解标准，报告了一大系列接受分泌性垂体腺瘤手术患者的临床结果。本研究纳入了由两位相同神经外科医生手术治疗的125例连续分泌性垂体腺瘤患者（42例泌乳素分泌型、67例生长激素分泌型和16例促肾上腺皮质激素分泌型腺瘤）。56%的患者实现了疾病的生化缓解；微腺瘤患者和大腺瘤患者的缓解率分别为78%和47%。未观察到死亡病例或严重的术后即刻并发症。肿瘤大小、高激素水平和硬膜侵犯与手术效果不佳显著相关。复发率在0%至24%之间，泌乳素分泌型肿瘤的复发率更高。总之，经蝶窦手术在分泌性垂体肿瘤中是安全有效的。它仍然是生长激素和促肾上腺皮质激素分泌型腺瘤的首选治疗方法，而对于泌乳素瘤患者，手术应保留用于对多巴胺激动剂耐药或不耐受的病例。
