Outcome of Transsphenoidal Surgery for Cushing Disease: A Single-Center Experience Over 32 Years
Outcome of Transsphenoidal Surgery for Cushing Disease: A Single-Center Experience Over 32 Years
复制标题
DOI：
10.1227/neu.0000000000001011
复制
发表时间：
2016-02-01
期刊：
影响因子：
4.8
通讯作者：
Schteingart, David E.
中科院分区：
文献类型：
--
作者：
Chandler, William F.;Barkan, Ariel L.;Schteingart, David E.
背景：经蝶手术是治疗库欣病的标准方法。需要证据来证明有效性。目的：分析 276 名连续患者（包括 19 名儿童）的经蝶手术结果。方法：回顾 1980 年至 2012 年首次接受库欣病手术治疗的患者的病历。记录放射学特征、病理、缓解、复发和并发症。根据肿瘤大小（微腺瘤、大腺瘤和阴性影像）和缓解类型（1 型 = 早晨皮质醇 3 g/dL；2 型 = 早晨皮质醇正常）对患者进行分类进行统计分析。 结果：女性占患者的 78%，且年龄大于男性。影像学显示 50% 为微腺瘤，13% 为大腺瘤，37% 为肿瘤阴性。微腺瘤、大腺瘤和阴性影像的缓解率分别为 89%、66% 和 71%。患有微腺瘤的患者更有可能获得 1 型缓解。病理学显示，82% 的微腺瘤、100% 的大腺瘤和 43% 的阴性影像显示促肾上腺皮质激素分泌腺瘤。增生的发生率为8%。病理学上发现增生或无肿瘤预示着治疗失败。复发率为17%，平均复发时间为4.0年。 1 型缓解的患者复发率较低（1 型 13%，2 型 50%），且复发时间较长。儿童具有相似的影像学表现、缓解率和病理学结果。无手术死亡病例。结论：经蝶手术为库欣病提供了安全有效的治疗方法。对于成人和儿童，最好的结果发生在微腺瘤患者和/或 1 型缓解患者中。缩写：ACTH、促肾上腺皮质激素 IPSS、岩下窦取样
BACKGROUND:Transsphenoidal surgery is the standard approach for treating Cushing disease. Evidence is needed to document effectiveness.OBJECTIVE:To analyze results of transsphenoidal surgery in 276 consecutive patients, including 19 children.METHODS:Medical records were reviewed for patients treated initially with surgery for Cushing disease from 1980 to 2012. Radiographic features, pathology, remissions, recurrences, and complications were recorded. Patients were categorized for statistical analysis based on tumor size (microadenomas, macroadenomas, and negative imaging) and remission type (type 1 = morning cortisol 3 g/dL; type 2 = morning cortisol normal).RESULTS:Females comprised 78% of patients and were older than men. Imaging showed 50% microadenomas, 13% macroadenomas, and 37% negative for tumor. Remission rates for microadenomas, macroadenomas, and negative imaging were 89%, 66%, and 71%, respectively. Patients with microadenomas were more likely to have type 1 remission. Pathology showed adrenocorticotropic hormone-secreting adenomas in 82% of microadenomas, in 100% of macroadenomas, and in 43% of negative imaging. The incidence of hyperplasia was 8%. The finding of hyperplasia or no tumor on pathology predicted treatment failure. The recurrence rate was 17%, with an average time to recurrence of 4.0 years. Patients with type 1 remission had a lower rate of recurrence (13% type 1 vs 50% type 2) and a longer time to recurrence. Children had similar imaging findings, remission rates, and pathology. There were no operative deaths.CONCLUSION:Transsphenoidal surgery provides a safe and effective treatment for Cushing disease. For both adults and children, the best outcomes occurred in patients with microadenomas and/or those with type 1 remission.ABBREVIATIONS:ACTH, adrenocorticotropic hormoneIPSS, inferior petrosal sinus sampling