Pituitary Centre Nijmegen, Department of Endocrinology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
Acta Neurochir (Wien). 2011 Jul;153(7):1391-9. doi: 10.1007/s00701-011-0959-8. Epub 2011 Feb 24.
Transsphenoidal pituitary surgery (TS) is the primary treatment of choice for patients with acromegaly. Macroadenomas (>1 cm) are more difficult to resect than microadenomas (remission rate ± 50% compared to ± 90%). Besides the conventional microscopic TS, the more recently introduced endoscopic technique is nowadays frequently used. However, no large series reporting on its results have yet been published. We evaluated the outcome of endoscopic TS in 40 patients with a growth hormone (GH)-secreting macroadenoma treated in our hospital between 1998 and 2007.
Medical records were retrospectively reviewed. Remission was defined as disappearance of clinical symptoms of acromegaly, normal serum insulin-like growth factor-1 levels (≤2 SD) and serum GH levels suppressed to <2 mU/l after an oral glucose tolerance test within the first 4 months after TS.
In four patients TS aimed at debulking of the tumour. In the remaining 36 patients, remission was achieved in 20 patients. In the first 5 years remission was achieved in 6 out of 18 patients (33%) compared to 14 out of 22 patients (63%) in the following 5 years (p = 0.06). Thirteen patients had a mild perioperative complication. Before TS 15 patients received hormonal substitution therapy compared to 12 patients (33%) after TS.
Endoscopic TS is a good primary therapeutic option for patients with a GH-secreting macroadenoma, resulting in a remission rate of up to 63% in experienced hands. This technique can potentially improve the outcome of TS in these patients.
经蝶窦垂体手术（TS）是治疗肢端肥大症患者的首选方法。大腺瘤（>1 厘米）比微腺瘤（缓解率±50%，而±90%）更难切除。除了传统的显微镜 TS 外，最近引入的内镜技术现在经常使用。然而，还没有报道其结果的大型系列。我们评估了 1998 年至 2007 年间在我院接受治疗的 40 例生长激素（GH）分泌性大腺瘤患者内镜 TS 的结果。
回顾性查阅病历。缓解定义为肢端肥大症的临床症状消失、胰岛素样生长因子-1 水平正常（≤2 个标准差）和口服葡萄糖耐量试验后 4 个月内血清 GH 水平降至<2 mU/L。
在 4 例患者中，TS 的目的是肿瘤的减瘤。在其余 36 例患者中，20 例患者达到缓解。在最初的 5 年内，18 例患者中有 6 例（33%）达到缓解，而在接下来的 5 年内，22 例患者中有 14 例（63%）达到缓解（p=0.06）。13 例患者有轻度围手术期并发症。在 TS 之前，15 例患者接受了激素替代治疗，而在 TS 之后，12 例患者（33%）接受了激素替代治疗。
内镜 TS 是 GH 分泌性大腺瘤患者的一种良好的主要治疗选择，在经验丰富的手中缓解率高达 63%。该技术可能会改善这些患者 TS 的结果。
