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肢端肥大症的术前治疗和手术方法:系统评价。

Preoperative medical treatments and surgical approaches for acromegaly: A systematic review.

机构信息

Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

出版信息

Clin Endocrinol (Oxf). 2023 Jan;98(1):14-31. doi: 10.1111/cen.14790. Epub 2022 Jun 30.

Abstract

OBJECTIVE

Acromegaly is a condition characterized by an overproduction of growth hormone which infers high morbidity and mortality if left untreated. The objective of this review is to analyse and appraise the current evidence for the generalized use of preoperative medications and the various surgical approaches as described in the literature.

DESIGN

A thorough search from MEDLINE via PubMed, EMBASE, and Cochrane Library has been performed which identified a total of 37 papers.

CONCLUSION

The preoperative use of somatostatin receptor agonists (SAs) in acromegaly is a controversial topic with current guidelines suggesting against their generalized routine use. Most authors noticed an insignificant long-term remission of acromegaly when given SAs compared with nil preoperative therapy, except for invasive macroadenomas as SAs have been found to reduce the tumour volume and aid towards the total resection of the adenoma. Furthermore, according to the evidence available, endoscopic transsphenoidal surgery is the optimum method for hypophysectomy in terms of its remission and safety profile.

摘要

目的

肢端肥大症是一种由生长激素过度分泌引起的疾病,如果不进行治疗,其发病率和死亡率都很高。本综述的目的是分析和评估文献中描述的术前药物治疗和各种手术方法的现有证据。

设计

通过 MEDLINE 经 PubMed、EMBASE 和 Cochrane Library 进行了全面检索,共确定了 37 篇论文。

结论

肢端肥大症术前使用生长抑素受体激动剂(SAs)是一个有争议的话题,目前的指南建议不要常规使用。大多数作者注意到,与无术前治疗相比,给予 SAs 后肢端肥大症的长期缓解并不显著,除了侵袭性大腺瘤,因为 SAs 已被发现可减少肿瘤体积,并有助于腺瘤的完全切除。此外,根据现有证据,内镜经蝶窦手术在缓解率和安全性方面是垂体切除术的最佳方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b78e/10084190/b4f919720c8b/CEN-98-14-g002.jpg

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