Feng Ming, Yao Yong, Deng Kan, Xing Bing, Lian Wei, Li Gui-lin, Wei Jun-ji, Dou Wan-chen, Bao Xin-jie, Liu Xiao-hai, Dai Cong-xin, Gao Jun, Wang Yu, Ma Wen-bin, Yang Yi, Zhong Ding-rong, Wang Ren-zhi
Department of Neurosurgery, Peking Union Medical College Hospital & Chinese Academy of Medical Sciences, Beijing 100730, China.
Department of Neurosurgery, Peking Union Medical College Hospital & Chinese Academy of Medical Sciences, Beijing 100730, China. Email:
Zhonghua Yi Xue Za Zhi. 2013 Sep 17;93(35):2813-5.
To explore the significance of pseudocapsule in the excision of pituitary adenomas in transsphenoidal surgery.
For 22 patients with pituitary adenomas over a period of 2 years at Peking Union Medical College Hospital, resection of pseudocapsule was applied for complete tumor removal. Pituitary function test and radiological imaging were performed at pre-operation, 3 months post-operation and at subsequent 6-12 months intervals postoperatively.
All pituitary adenomas were totally removed under microscope. The symptoms of headache, disorder of sight and visual field disappeared postoperatively in nonfunctional pituitary adenomas. The GH levels of 2/5 growth hormone secreting adenoma patients were 4.2 and 7.7 µg/L while it was under 1 µg/L for another 3. The postoperative level of prolactin was 4.3 µg/L in prolactin secreting adenoma. The level of adrenocorticotropic hormone decreased under 5 ng/L except one was 15.7 ng/L. Leakage of cerebrospinal fluid occurred intraoperatively in 3 patients and postoperatively in 1. No leakage was found after repair. Diabetes insipidus occurred in one patient and was controlled with Minirin. Pseudocapsule was confirmed by pathological examination. Special staining revealed reticulum fibers in pseudocapsule.
Resection of pseudocapsule may achieve a higher remission rate without deteriorating pituitary function.
探讨假包膜在经蝶窦手术切除垂体腺瘤中的意义。
在北京协和医院对22例垂体腺瘤患者进行了为期2年的研究，采用切除假包膜的方法以实现肿瘤的完全切除。在术前、术后3个月以及随后术后6 - 12个月的间隔时间进行垂体功能测试和影像学检查。
所有垂体腺瘤均在显微镜下完全切除。无功能垂体腺瘤患者术后头痛、视力及视野障碍症状消失。5例生长激素分泌型腺瘤患者中，2例的生长激素水平分别为4.2和7.7μg/L，另外3例低于1μg/L。泌乳素分泌型腺瘤患者术后泌乳素水平为4.3μg/L。促肾上腺皮质激素水平除1例为15.7ng/L外，其余均降至5ng/L以下。3例患者术中发生脑脊液漏，1例术后发生脑脊液漏，修补后未再发现漏液。1例患者发生尿崩症，用弥凝控制。病理检查证实有假包膜。特殊染色显示假包膜中有网状纤维。
切除假包膜可在不损害垂体功能的情况下实现更高的缓解率。
