CAJ | 학술논문

目的探讨垂体腺瘤假包膜在经蝶窦入路垂体腺瘤切除术中的意义.方法回顾性分析北京协和医院神经外科2010至2012年间经手术和病理证实的有明确垂体腺瘤假包膜的垂体腺瘤病例22例,其中垂体促肾上腺皮质激素(ACTH)腺瘤5例,垂体无功能腺瘤11例,垂体生长激素腺瘤5例,垂体泌乳素(PRL)腺瘤1例.术后随访2～24个月.初步探讨利用垂体腺瘤假包膜行包膜外切除对垂体功能、肿瘤复发的影响.结果 22例垂体腺瘤患者均在手术显微镜下全部切除.垂体无功能瘤患者头痛、视力、视野改善.5例垂体生长激素腺瘤术后葡萄糖生长激素抑制(OGTT)试验:3例生长激素均降至1 μg/L以下,2例生长激素分别为4.2μg/L(术前22μg/L)、7.7 μg/L(术前66μg/L),并在随访中.1例垂体PRL腺瘤术后PRL为4.3μg/L.5例垂体ACTH腺瘤术后ACTH除1例为15.7 ng/L,其余均降至5 ng/L以下.1例术后脑脊液漏,修补后效果良好.1例术后一过性尿崩.病理诊断均为垂体腺瘤,周边可见假包膜.结论经蝶窦入路切除垂体腺瘤过程中,利用假包膜囊外切除可全切肿瘤,保护正常垂体功能,减少复发.
목적 탐토수체선류가포막재경접두입로수체선류절제술중적의의.방법 회고성분석북경협화의원신경외과2010지2012년간경수술화병리증실적유명학수체선류가포막적수체선류병례22례,기중수체촉신상선피질격소(ACTH)선류5례,수체무공능선류11례,수체생장격소선류5례,수체비유소(PRL)선류1례.술후수방2～24개월.초보탐토이용수체선류가포막행포막외절제대수체공능、종류복발적영향.결과 22례수체선류환자균재수술현미경하전부절제.수체무공능류환자두통、시력、시야개선.5례수체생장격소선류술후포도당생장격소억제(OGTT)시험:3례생장격소균강지1 μg/L이하,2례생장격소분별위4.2μg/L(술전22μg/L)、7.7 μg/L(술전66μg/L),병재수방중.1례수체PRL선류술후PRL위4.3μg/L.5례수체ACTH선류술후ACTH제1례위15.7 ng/L,기여균강지5 ng/L이하.1례술후뇌척액루,수보후효과량호.1례술후일과성뇨붕.병리진단균위수체선류,주변가견가포막.결론 경접두입로절제수체선류과정중,이용가포막낭외절제가전절종류,보호정상수체공능,감소복발.
Objective To explore the significance of pseudocapsule in the excision of pituitary adenomas in transsphenoidal surgery.Methods For 22 patients with pituitary adenomas over a period of 2 years at Peking Union Medical College Hospital,resection of pseudocapsule was applied for complete tumor removal.Pituitary function test and radiological imaging were performed at pre-operation,3 months post-operation and at subsequent 6-12 months intervals postoperatively.Results All pituitary adenomas were totally removed under microscope.The symptoms of headache,disorder of sight and visual field disappeared postoperatively in nonfunctional pituitary adenomas.The GH levels of 2/5 growth hormone secreting adenoma patients were 4.2 and 7.7 μg/L while it was under 1 μg/L for another 3.The postoperative level of prolactin was 4.3 μg/L in prolactin secreting adenoma.The level of adrenocorticotropic hormore decreased under 5 ng/L except one was 15.7 ng/L.Leakage of cerebrospinal fluid occurred intraoperatively in 3 patients and postoperatively in 1.No leakage was found after repair.Diabetes insipidus occurred in one patient and was controlled with Minirin.Pseudocapsule was confirmed by pathological examination.Special staining revealed reticulum fibers in pseudocapsule.Conclusion Resection of pseudocapsule may achieve a higher remission rate without deteriorating pituitary function.