CAJ | 학술논문

目的探讨经蝶窦入路手术治疗MRI阴性的库欣病患者的疗效.方法回顾性总结北京协和医院神经外科2012年1月至2014年1月经蝶窦入路手术的库欣病患者共118例,其中MRI阴性的43例,同期MRI阳性的垂体ACTH微腺瘤75例.结果 43例MRI阴性患者术后内分泌缓解率为74.4％(32/43),38例病理学诊断垂体腺瘤(88.4％);75例MRI阳性患者术后内分泌缓解率为85.3％(64/75),71例病理学诊断垂体腺瘤(94.7％).两组内分泌缓解者随访1～3年均未见肿瘤复发.统计分析证实MRI阴性、阳性两组内分泌缓解率、病理阳性率差异无统计学意义(P＞0.05).MRI阴性患者32例行IPSS,31例IPSS阳性,术后27例内分泌缓解,5例术后未缓解,其中28例病理学诊断为垂体腺瘤.结论 MRI阴性的库欣病患者术后内分泌缓解率、病理阳性率与MRI阳性患者相比无明显差异.对于MRI阴性者,IPSS阳性者首选经蝶窦入路探查.
목적 탐토경접두입로수술치료MRI음성적고흔병환자적료효.방법 회고성총결북경협화의원신경외과2012년1월지2014년1월경접두입로수술적고흔병환자공118례,기중MRI음성적43례,동기MRI양성적수체ACTH미선류75례.결과 43례MRI음성환자술후내분비완해솔위74.4％(32/43),38례병이학진단수체선류(88.4％);75례MRI양성환자술후내분비완해솔위85.3％(64/75),71례병이학진단수체선류(94.7％).량조내분비완해자수방1～3년균미견종류복발.통계분석증실MRI음성、양성량조내분비완해솔、병리양성솔차이무통계학의의(P＞0.05).MRI음성환자32례행IPSS,31례IPSS양성,술후27례내분비완해,5례술후미완해,기중28례병이학진단위수체선류.결론 MRI음성적고흔병환자술후내분비완해솔、병리양성솔여MRI양성환자상비무명현차이.대우MRI음성자,IPSS양성자수선경접두입로탐사.
Objective To analyze the outcome in patients who underwent transsphenoidal surgery (TSS) with Cushing's disease (CD) with no visible adenoma on magnetic resonance imaging (MRI).Methods Between 2012 and 2014,118 patients with CD underwent TSS at PUMCH.We retrospectively analyzed data in 43 patients without visible adenomas on MRI and compared them with 75 patients with MRI-visible microadenomas.Results Of 75 patients with MRI-visible microadenomas, postoperative remission was achieved in 64 patients (85.3％), and no recurrence or persistent of CD was observed during 2-year follow-up, and pituitary adenoma confirmed by pathology examination in 71 cases.Of 43 patients with negative MRI, postoperative remission was achieved in 32 patients (74.4％), and pituitary adenoma confirmed by pathology examination in 38 cases.No statistic difference was found between MRI-negative group and MRI-visible group after x2 test (P value ＞ 0.05).BIPSS was performed in 32 cases, and 27 cases were positive.Pituitary adenoma was confirmed in 28 cases.Conclusion There is no difference in remission rate of CD in MRI-visible and MRI-negative group.BIPSS should be performed in normal MRI cases.We recommend transsphenoidal surgery as the first-line treatment for CD.Selective adenomectomy was recommended when an adenoma was found during surgery, and partial or hemihypophysectomy when no adenoma was found.