经蝶窦手术后复发性库欣病的重复经蝶窦手术或伽玛刀放射外科治疗。
Repeated transsphenoidal surgery or gamma knife radiosurgery in recurrent cushing disease after transsphenoidal surgery.
作者信息
Bodaghabadi Mohammad, Riazi Hooman, Aran Shima, Bitaraf Mohammad Ali, Alikhani Mazdak, Alahverdi Mahmud, Mohamadi Masoumeh, Shalileh Keivan, Azar Maziar
机构信息
Department of Neuroradiosurgery, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.
Department of Neurosurgery, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Islamic Republic of Iran.
出版信息
J Neurol Surg A Cent Eur Neurosurg. 2014 Mar;75(2):91-7. doi: 10.1055/s-0033-1345688. Epub 2013 Aug 21.
BACKGROUND
This study compared Gamma knife radiosurgery (GKRS) and repeated transsphenoidal adenomectomy (TSA) to find the best approach for recurrence of Cushing disease (CD) after unsuccessful first TSA.
MATERIAL AND METHODS
Fifty-two patients with relapse of CD after TSA were enrolled and randomly underwent a second surgery or GKRS as the next therapeutic approach. They were followed for a mean period of 3.05 ± 0.8 years by physical examination and hormone measurement as well as magnetic resonance imaging.
RESULTS
No significant difference was observed in sex ratio, mean age, adenoma type, follow-up duration, and initial hormone level between the two groups. No significant relationship was found between preoperative 24-hour free urine cortisol and disease-free months or tumor volume among both groups. Our statistical analysis showed higher recurrence-free interval in the GKRS group compared with TSA group.
CONCLUSION
With longer recurrence-free interval, GKRS could be considered a good treatment alternative to repeated TSA in recurrent CD.
背景
本研究比较了伽玛刀放射外科手术（GKRS）和重复经蝶窦腺瘤切除术（TSA），以寻找首次TSA手术失败后库欣病（CD）复发的最佳治疗方法。
材料与方法
纳入52例TSA术后CD复发患者，随机接受二次手术或GKRS作为下一步治疗方法。通过体格检查、激素测量以及磁共振成像对患者进行平均3.05±0.8年的随访。
结果
两组在性别比例、平均年龄、腺瘤类型、随访时间和初始激素水平方面均未观察到显著差异。两组术前24小时尿游离皮质醇与无病月数或肿瘤体积之间均未发现显著关系。我们的统计分析表明，与TSA组相比，GKRS组的无复发生存期更长。
结论
由于无复发生存期更长，GKRS可被视为复发性CD患者重复TSA手术的良好替代治疗方法。
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