Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele University Health Institute, Milan, Italy.
Endocrine. 2018 Jan;59(1):72-81. doi: 10.1007/s12020-017-1458-3. Epub 2017 Oct 24.
We report the efficacy and safety of transsphenoidal microsurgery in a large and homogeneous cohort of patients with pituitary adenomas (PAs) treated at a single Institute by a single neurosurgeon.
A total of 2145 consecutive patients undergoing first surgery for a PA were included: 795 (37.1%) had a nonfunctioning pituitary adenoma (NFPA), 595 (27.7%) acromegaly, 496 (23.1%) Cushing's disease, 208 (9.7%) a PRL-secreting adenoma, and 51 patients (2.4%) a TSH-secreting adenoma. Remission was achieved when strict hormonal and radiological criteria were met.
Early surgical remission was achieved in 66% of acromegalic patients, 79.6% of patients with Cushing's disease, 64.4% of prolactinomas, 74.5% of patients with a TSH-secreting adenoma, and 66.9% of NFPAs. The mean (±SE) follow-up was 60.1 ± 1.3 months. The recurrence-free survival at 10 years was 78.2% in acromegalic patients, 68.1% in prolactinomas, 74.3% in Cushing's disease, 70.3% in TSH-secreting adenomas, and 75.3% in NFPAs. Preoperative hypoadrenalism recovered in 35.3%, hypogonadism in 43.3% and hypothyroidism in 37.4% of patients with impaired function before surgery. The mortality rate was 0.2% and major morbidity 2.1%. New onset hypoadrenalism occurred after surgery in 2.5% of patients at risk, hypogonadism in 4.1%, and hypothyroidism in 1.8%. Permanent diabetes insipidus (DI) occurred in 0.9% of patients.
In experienced hands, transsphenoidal microsurgery for PAs achieves remission in most patients with a low complication rate. Pituitary function is preserved in most cases and can recover in more than one-third of patients with preoperative hypopituitarism.
我们报告了在一家机构由一位神经外科医生对一组大型且同质的垂体腺瘤（PA）患者进行经蝶窦显微手术的疗效和安全性。
共纳入 2145 例首次接受 PA 手术的连续患者：795 例（37.1%）为无功能垂体腺瘤（NFPA），595 例（27.7%）为肢端肥大症，496 例（23.1%）为库欣病，208 例（9.7%）为催乳素分泌腺瘤，51 例（2.4%）为促甲状腺激素分泌腺瘤。当严格的激素和影像学标准得到满足时，即达到早期手术缓解。
在肢端肥大症患者中，66%的患者获得早期手术缓解，79.6%的库欣病患者、64.4%的催乳素瘤患者、74.5%的促甲状腺激素分泌腺瘤患者和 66.9%的 NFPA 患者达到缓解。平均（±SE）随访时间为 60.1±1.3 个月。10 年无复发生存率在肢端肥大症患者中为 78.2%，催乳素瘤患者中为 68.1%，库欣病患者中为 74.3%，促甲状腺激素分泌腺瘤患者中为 70.3%，NFPA 患者中为 75.3%。术前功能受损的患者中，术后 35.3%的肾上腺功能减退症、43.3%的性腺功能减退症和 37.4%的甲状腺功能减退症得到恢复。死亡率为 0.2%，主要发病率为 2.1%。有风险的患者术后新发肾上腺功能减退症 2.5%，性腺功能减退症 4.1%，甲状腺功能减退症 1.8%。永久性尿崩症（DI）的发生率为 0.9%。
在经验丰富的医生手中，经蝶窦显微手术治疗 PA 可使大多数患者获得缓解，并发症发生率较低。大多数情况下保留了垂体功能，术前垂体功能减退的患者中有三分之一以上可以恢复。
