LONG‐TERM RESULTS OF TRANSSPHENOIDAL PITUITARY MICROSURGERY IN 60 ACROMEGALIC PATIENTS
LONG‐TERM RESULTS OF TRANSSPHENOIDAL PITUITARY MICROSURGERY IN 60 ACROMEGALIC PATIENTS
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60 例肢端肥大症患者经蝶垂体显微手术的长期结果
DOI：
10.1111/j.1365-2265.1985.tb01116.x
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发表时间：
1985
影响因子：
3.2
通讯作者：
M. Frölich
中科院分区：
文献类型：
--
作者：
F. Roelfsema;H. Dulken;M. Frölich
对60例临床和生化活动性肢端肥大症患者行经蝶手术治疗。所有患者在手术前和手术后都接受了全面的垂体功能评估；这些研究在手术后6个月和每年都重复进行，如果可能的话。平均随访3.3年(0.5~7年)。62%的患者术后GH水平恢复正常。35例患者术前存在生长激素对TRH的反常反应，17例患者术后恢复正常。与小肿瘤相比，大肿瘤与更高的生长激素水平有关。根据生长激素水平的正常化和对TRH或葡萄糖挑战的最终矛盾反应，一个预后因素是术前低生长激素水平。术后TRH试验阳性但GH水平正常或GH水平轻度升高的7例患者中，有3例出现生化和临床复发，其中2例再次手术。相反，当TRH试验正常(总是与正常的GH水平相关)时，没有发现复发。手术对其他垂体功能的影响一般较小，术前术后受损的患者数量大致相同。术后对生长激素水平升高的患者进行放射治疗，无论生长激素水平是否已正常化，或肿瘤的局部侵袭，均进行非正常化的TRH试验。在17例术后GH水平升高的患者中，有11例在平均2.7年后通过放射治疗恢复正常。照射后垂体功能衰竭的发生率似乎很高；男性的性腺功能和生长激素储备功能尤其脆弱。从这项研究中我们得出结论，在许多情况下，腺瘤可以被有效地切除，而不会损害其他垂体功能。然而，相当多的患者需要额外的放射治疗，从而不可避免地导致其他垂体功能的丧失。
Sixty patients with clinically and biochemically active acromegaly were treated by transsphenoidal surgery. All patients underwent a full assessment of pituitary function both preoperatively and postoperatively; these studies were repeated 6 months after surgery and every year, when possible. The mean follow‐up period was 3.3 years (range 0.5‐7 years). The GH level normalized in 62% of patients after surgery. A paradoxical reaction of GH to TRH was present in 35 patients before surgery and had normalized in 17 after surgery. Large tumours were associated with higher GH levels than smaller tumours. A prognostic factor in terms of normalization of both the GH level and an eventual paradoxical reaction to TRH or a glucose challenge was a low preoperative GH level. Three out of seven patients with either a positive postoperative TRH test but a normal GH level, or a slightly elevated GH level suffered a biochemical and clinical recurrence and two of them underwent reoperation. In contrast, when the TRH test had normalized (always in association with normal GH levels) no recurrence was found. The impact of surgery on the other pituitary functions was generally slight and the numbers of patients with preoperative and postoperative impairment were about equal. Postsurgical radiation therapy was administered to patients with an elevated GH level, a non‐normalized TRH test irrespective of whether the GH level had normalized, or local invasion of the tumour. In 11 out of 17 patients with elevated GH levels after surgery, normalization was achieved by radiation therapy after a mean period of 2.7 years. The incidence of pituitary failure after irradiation appeared to be high; gonadal function in men and the GH reserve function were especially vulnerable. From this study we conclude that in many cases the adenoma can be removed effectively, without compromising the other pituitary functions. However, a substantial number of the patients require additional radiation therapy, leading to an inevitable loss of other pituitary functions.
肢端肥大症：重新评估经蝶垂体手术的长期治疗效果。
影响因子：
39.2
作者：
Schuster,LD;Bantle,JP;Oppenheimer,JH;Seljeskog,EL
通讯作者：
Seljeskog,EL