Boggan J E, Tyrrell J B, Wilson C B
J Neurosurg. 1983 Aug;59(2):195-200. doi: 10.3171/jns.1983.59.2.0195.
The development of transsphenoidal microsurgery and the refinement of endocrinological and radiological diagnostic procedures have afforded therapeutic options appropriate to the individual case in patients with hypercortisolism. The present series of 100 cases is derived from 104 patients with the diagnosis of Cushing's disease who underwent transsphenoidal pituitary exploration between 1974 and 1981. Excluding four patients in whom the pituitary gland was not exposed because of intraoperative technical difficulties, an overall cure rate of 78% was achieved. Among 71 patients with tumors confined to the sella turcica, 87% had correction of their hypercortisolism, 11% represented therapeutic failures, and one patient had tumor recurrence. In contrast, among 25 patients with extrasellar extension, correction of hypercortisolism was achieved in only 48%, 40% failed to respond, and 12% of the patients had recurrence. Four patients who failed to respond to total hypophysectomy have ectopic sources of adenocorticotropic hormone. The results indicate that transsphenoidal microsurgical exploration for a basophilic adenoma is the procedure of choice in adults and children with Cushing's disease. The diagnostic and surgical approach to these tumors, as well as pitfalls in the transsphenoidal treatment of Cushing's disease, are discussed.
经蝶窦显微手术的发展以及内分泌和放射诊断程序的完善，为库欣综合征患者提供了适合个体情况的治疗选择。本系列100例病例来自1974年至1981年间接受经蝶窦垂体探查术、诊断为库欣病的104例患者。排除4例因术中技术困难未暴露垂体的患者，总体治愈率达78%。在71例肿瘤局限于蝶鞍的患者中，87%的患者高皮质醇血症得到纠正，11%为治疗失败，1例患者肿瘤复发。相比之下，在25例有鞍外扩展的患者中，仅48%的患者高皮质醇血症得到纠正，40%无反应，12%的患者复发。4例对全垂体切除术无反应的患者存在促肾上腺皮质激素异位来源。结果表明，经蝶窦显微手术探查嗜碱性腺瘤是成人和儿童库欣病的首选治疗方法。本文讨论了这些肿瘤的诊断和手术方法，以及经蝶窦治疗库欣病的陷阱。
