Lenzi J, Lapadula G, D'amico T, Delfinis C P, Iuorio R, Caporlingua F, Mecca N, Mercuri V, Bassotti G, Rillo M, Santoro F, Tamburrano G, Santoro A, Gargiulo P
Division of Neurosurgery Department of Neurological Sciences Sapienza University of Rome Policlinico Umberto I, Rome, Italy -
J Neurosurg Sci. 2015 Mar;59(1):11-8.
Acromegaly is caused by a GH-secreting pituitary adenoma, associated with many comorbidities and increased risk of mortality. Surgery is the first-line therapy. Success of therapy is measured by symptomatic improvement, preservation of pituitary function and biochemical control. Trans-sphenoidal surgery (TSS), endoscopic or microscopic, is the preferred treatment. To evaluate surgery effectiveness and individuate the technique associated with a higher remission rate, patients undergoing TSS were retrospectively selected.
Thirty-seven consecutive patients underwent surgery between 1996 and 2006. Tumors were classified into macroadenomas or microadenomas and into intrasellar, extrasellar and extrasellar with cavernous sinus invasion. Surgery was performed in 22 patients with endoscopic technique, in 15 patients with microsurgical approach. The hormonal assays were performed 6 months and yearly after surgery for an average of 5 years.
Ten patients were affected by microadenoma, 27 by macroadenoma. In microadenomas remission rate was independent of the used technique. Within macroadenomas, remission percentage in endoscopic approach (68.75%) was significantly higher than in microscopic approach (18.18%) (P=0.018). Postsurgical biochemical remission was calculated combining the surgical technique and tumor extension: the endoscopic approach was associated with a significantly higher remission rate in extrasellar than both in intrasellar and extrasellar with cavernous sinus invasion. In the latter group, any technique had not reached biochemical remission.
TSS is able to induce a long-term remission of acromegaly, with low risk of recurrence and complications. Endoscopic approach is more suitable than microscopic technique in macroadenomas and adenomas with suprasellar extension.
肢端肥大症由分泌生长激素的垂体腺瘤引起，与多种合并症及死亡风险增加相关。手术是一线治疗方法。治疗成功与否通过症状改善、垂体功能保留及生化指标控制来衡量。经蝶窦手术（TSS），无论是内镜手术还是显微镜手术，都是首选治疗方式。为评估手术效果并确定与更高缓解率相关的技术，对接受TSS的患者进行了回顾性选择。
1996年至2006年间，37例连续患者接受了手术。肿瘤被分为大腺瘤或微腺瘤，以及鞍内、鞍外和侵犯海绵窦的鞍外肿瘤。22例患者采用内镜技术进行手术，15例患者采用显微手术方法。术后6个月及每年进行激素测定，平均持续5年。
10例患者为微腺瘤，27例为大腺瘤。微腺瘤的缓解率与所采用的技术无关。在大腺瘤中，内镜手术的缓解率（68.75%）显著高于显微手术（18.18%）（P = 0.018）。结合手术技术和肿瘤范围计算术后生化缓解情况：内镜手术在鞍外肿瘤中的缓解率显著高于鞍内肿瘤及侵犯海绵窦的鞍外肿瘤。在后者组中，任何技术均未达到生化缓解。
TSS能够诱导肢端肥大症长期缓解，复发和并发症风险低。对于大腺瘤及鞍上扩展的腺瘤，内镜手术比显微技术更合适。
