CAJ | 학술논문

目的探讨育龄期女性垂体瘤的临床、病理、影像学特点、治疗方式、术后常见并发症及临床症状.方法分析387例15 ～ 50岁的育龄期垂体瘤女性患者的临床资料并对患者进行随访.结果 387例育龄期女性垂体瘤患者中,92.95％由内分泌表现就诊(月经紊乱、停经及溢乳等),且年龄越小、术前生长激素及催乳素水平越高越以内分泌表现就诊.大腺瘤占69.5％、30岁以上占60.21％,肿瘤大小与年龄呈正相关.催乳素瘤最常见(34.1％)、58.7％为侵袭性垂体瘤,肿瘤的侵袭性与术前催乳素水平、肿瘤大小、术前有无内分泌表现及垂体卒中有关,352例(95.4％)行经蝶窦切除术,术后1周内常见的并发症及临床症状为:多尿(71.5％)、高钠血症(20.9％)、低钠血症(17.3％)及高热(5.0％),开颅手术引起术后血钠＜ 130 mmol/L或＞150 mmol/L水平者是经蝶手术路径的19.7倍,年龄越大,术后发生多尿几率越高;手术后3个月后,随访人群LH、FSH、ACTH和促甲状腺激素减低的比例分别为7.5％、7.5％、5.3％和4.4％,术后垂体前叶功能减退与术前垂体功能减退和肿瘤大小无关(P＞0.05);最常见临床症状为嗅觉减退(22.47％),其次为乏力(19.82％)及性功能下降(16.74％);术后氢化可的松替代剂量在10～20 mg/d,左旋甲状腺素片在50 ～ 75 μg/d.结论育龄期女性垂体瘤患者主要表现为月经紊乱、停经及溢乳,大腺瘤、催乳素瘤及侵袭性腺瘤常见,经蝶手术后也可出现一系列并发症及临床症状,长期随访非常重要.
목적 탐토육령기녀성수체류적림상、병리、영상학특점、치료방식、술후상견병발증급림상증상.방법 분석387례15 ～ 50세적육령기수체류녀성환자적림상자료병대환자진행수방.결과 387례육령기녀성수체류환자중,92.95％유내분비표현취진(월경문란、정경급일유등),차년령월소、술전생장격소급최유소수평월고월이내분비표현취진.대선류점69.5％、30세이상점60.21％,종류대소여년령정정상관.최유소류최상견(34.1％)、58.7％위침습성수체류,종류적침습성여술전최유소수평、종류대소、술전유무내분비표현급수체졸중유관,352례(95.4％)행경접두절제술,술후1주내상견적병발증급림상증상위:다뇨(71.5％)、고납혈증(20.9％)、저납혈증(17.3％)급고열(5.0％),개로수술인기술후혈납＜ 130 mmol/L혹＞150 mmol/L수평자시경접수술로경적19.7배,년령월대,술후발생다뇨궤솔월고;수술후3개월후,수방인군LH、FSH、ACTH화촉갑상선격소감저적비례분별위7.5％、7.5％、5.3％화4.4％,술후수체전협공능감퇴여술전수체공능감퇴화종류대소무관(P＞0.05);최상견림상증상위후각감퇴(22.47％),기차위핍력(19.82％)급성공능하강(16.74％);술후경화가적송체대제량재10～20 mg/d,좌선갑상선소편재50 ～ 75 μg/d.결론 육령기녀성수체류환자주요표현위월경문란、정경급일유,대선류、최유소류급침습성선류상견,경접수술후야가출현일계렬병발증급림상증상,장기수방비상중요.
Objective To investigate the clinical features,pathology,imaging,treatment,and prognosis in women with pituitary adenomas during reproductive age.Methods Total 387 cases of 15-50 years old females with pituitary adenomas were analyzed and followed up.Results During reproductive age,92.5％ patients with pituitary adenomas complained of symptoms of menstrual disorders,menopause,galactorrhea and so on.The younger the patients,the higher preoperative growth hormone or prolactin levels,the more the patients were diagnosed by endocrine manifestation.69.5％ patients suffered from macroadenomas and 60.21％ patients were above 30 years old.Tumor size was positively related with patient's age.The common type was prolactinoma (34.1％).58.7％ patients were suffering from invasive pituitary adenomas.Invasiveness of tumor were related with preoperative prolactin levels,tumor size,presence of endocrine manifestations,and pituitary apoplexy.95.4％ patients underwent operation by transsphenoidal approach.The most common complications and clinical symptoms were polyuria (71.5％),hypernatremia (20.9％),hyponatremia (17.3％),and fever (5.0％) during the week after surgery.Craniotomy which caused the incidence of postoperative serum sodium level＜ 130 mmol/L or greater than 150 mmol/L was 19.7 times of that in transsphenoidal surgery.The older the age,the higher the incidence of postoperative polyuria was.Insufficiencies of luteinizing hormone,follicle-stimulating hormone,adrenocorticotropin,and thyroidstimulating hormone were found in 7.5％,7.5％,5.3％,and 4.4％ of patients respectively after 3 months of surgery.Postoperative hypopituitarism was not related with hypopituitarism and tumor size before surgery (P ＞ 0.05).The most common symptoms were hyposmia (22.47％),followed by fatigue (19.82％),and sexual dysfunction (16.74％) during the follow-up period.Replacement therapy consisted of daily 10-20 mg of hydrocortisone and 50-75 μg of levothyroxine after surgery.Conclusion The main clinical feature in female patients with pituitary adenomas during reproductive age were menstrual disorder,menopause,and galactorrhea.Macroadenomas,prolactinoma,and invasive pituitary adenomas were common.Post operation complications might develop after transsphenoidal surgery.It was very important to do a long-term follow up.