根据手术范式转变，治疗生长激素分泌性垂体腺瘤的手术和内分泌学结果。
Surgical and endocrinological outcomes in the treatment of growth hormone-secreting pituitary adenomas according to the shift of surgical paradigm.
机构信息
Endocrinology, Yonsei Brain Research Institute, Brain Korea 21 Project for Medical Science, Seoul, South Korea.
出版信息
Neurosurgery. 2012 Dec;71(2 Suppl Operative):ons192-203; discussion ons203. doi: 10.1227/NEU.0b013e318265a288.
BACKGROUND
Extensive data exist regarding the success rates and long-term outcomes of transsphenoidal adenomectomy (TSA) of growth hormone (GH)-secreting pituitary tumors; however, few data exist regarding the extent of adenomectomy.
OBJECTIVE
To evaluate surgical outcomes for the treatment of GH-secreting pituitary adenomas with regard to the extent of adenomectomy.
METHODS
A retrospective study of 282 patients with GH-secreting pituitary tumors who underwent TSA. Three surgical paradigms (1, 2, and 3) were applied, all of which differed in extent of adenomectomy. All participants were evaluated with oral glucose tolerance tests (OGTTs) at 6-month intervals for 1.5 years and combined pituitary function tests at 1.5-year intervals after TSA. All surgeries were conducted by a single neurosurgeon at a single medical center. Biochemical remission was defined with insulinlike growth factor 1 and OGTT results.
RESULTS
The overall surgical remission rates were 89%, 87%, 64%, 70%, and 50% (nadir GH <1 ng/mL on OGTTs: 96%, 95%, 73%, 84%, and 56%) for modified Hardy classifications I, II, IIIA, IIIB, and IV, respectively. The remission rates for modified Hardy classification I-IIIB improved to 42%, 68%, and 84% after application of surgical paradigms 1, 2, and 3, respectively (P = .002). Aggressive surgical resection did not worsen hypopituitarism. Among the 42 patients with modified Hardy classification IV, 24 (57%) achieved remission without recurrence after applying the aggressive paradigm 3 surgery.
CONCLUSION
An aggressive surgical approach may be critical to managing GH-secreting pituitary adenomas and does not increase the risk of postoperative hypopituitarism.
ABBREVIATIONS
ACTH, corticotropinCPFT, combined pituitary function testCV, coefficient of variationGH, growth hormoneOGTT, oral glucose tolerance testPRL, prolactinTSA, transsphenoidal adenomectomyTSH, thyroid-stimulating hormone.
背景
关于经蝶窦腺瘤切除术（TSA）治疗生长激素（GH）分泌性垂体瘤的成功率和长期结果有大量数据，但关于腺瘤切除术的范围的数据很少。
目的
评估 GH 分泌性垂体腺瘤的手术结果与腺瘤切除术的范围有关。
方法
对 282 例 GH 分泌性垂体瘤患者行 TSA 的回顾性研究。应用了三种手术模式（1、2 和 3），它们在腺瘤切除术的范围上有所不同。所有患者均在 TSA 后 1.5 年每隔 6 个月进行口服葡萄糖耐量试验（OGTT）和联合垂体功能试验检查。所有手术均由一位神经外科医生在一家医疗中心进行。生化缓解定义为胰岛素样生长因子 1 和 OGTT 结果。
结果
总体手术缓解率分别为 89%、87%、64%、70%和 50%（OGTT 下最低 GH<1ng/mL：96%、95%、73%、84%和 56%），改良 Hardy 分级分别为 I、II、IIIA、IIIB 和 IV。改良 Hardy 分级 I-IIIB 的缓解率分别提高至应用手术模式 1、2 和 3 后 42%、68%和 84%（P=.002）。积极的手术切除不会加重垂体功能减退。在 42 例改良 Hardy 分级 IV 的患者中，有 24 例（57%）在应用积极的 3 号手术模式后无复发并缓解。
结论
积极的手术方法可能对 GH 分泌性垂体瘤的治疗至关重要，并且不会增加术后垂体功能减退的风险。
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