目的 探讨腹部手术后患者发生肾上腺皮质功能减退的临床特点及诊治方法。方法 回顾性总结分析我院自2003年1月至2006年12月期间行腹部手术8 974例患者中17例术后确诊为并发肾上腺皮质功能减退者的临床资料。结果 本组腹部手术后肾上腺皮质功能减退的发生率为0.19%（17/8 974），女性患者多于男性患者，男女之比约为1∶2； 其中55~64岁者2例，65~75岁者12例，75岁以上者3例。临床表现以嗜睡及消化道症状为主。实验室检查尿皮质醇水平降低，促肾上腺皮质激素兴奋试验阳性。1例出现肾上腺危象死亡，其余病例经激素治疗后康复。结论 腹部手术后肾上腺皮质功能减退多数病因不明确。临床以嗜睡及消化道症状为主要表现。实验室检查是确诊和激素治疗的依据。多预后良好，但发生肾上腺危象时仍可危及生命。
摘要:目的:探讨神经内镜经单鼻腔蝶窦入路在切除垂体腺瘤中的临床应用。 方法:对58例垂体腺瘤患者进行手术切除。应用神经内镜直接自单鼻腔进入,暴露双侧蝶窦开口,打开蝶窦前壁进入蝶窦腔切除肿瘤。 结果: 肿瘤全部切除42例,约占 72%;次全切除16例,约占28%,无严重并发症。结论:神经内镜经单鼻腔蝶窦入路切除垂体腺瘤是一种更微创、暴露更好、并发症少的手术方式。Abstract: Objective: To investigate the clinic application of endoscopic end nasal transsphenoidal surgery for pituitary tumors. Methods: 58 patients were treated. A endoscope was used to open the anterior wall of the sphenoid sinus and resected tumors. Results: 42 cases (72%) underwent total resection, 16 cases (28%) underwent subtotal resection. No severe complications was found. Conclusion: Endoscopic end nasal transsphenoidal surgery for pituitary tumors can reduce the tissue trauma, improved visualization, more complete tumor removal, and reduce complications.
Multi-disciplinary team (MDT) is increasingly applied in oncology and refractory diseases. In recent years, MDT has also been applied in diagnosis and treatment of pituitary adenoma and related diseases. This review summarizes the advantages and characteristics of the MDT diagnosis and treatment mode, and analyzes the application and effect of the MDT diagnosis and treatment mode in the Center of Pituitary Adenoma and Related Diseases, West China Hospital, Sichuan University. So far, it has shown that MDT has advantages such as it is professional, full of collaborative interaction, and efficient and optimized. It is a platform of multi-disciplinary cooperation and resources in the diagnosis and treatment of difficult diseases. Case discussion in MDT mode is conducive to timely selection of the best treatment options for patients with pituitary adenoma and related diseases, providing a good learning platform for doctors with different professional backgrounds, and promoting the improvement of professional diagnosis and treatment level of doctors in related departments. The development of MDT will help us to use limited medical resources efficiently, promote the medical team to be more specialized, optimize the diagnosis and treatment process, and improve the effectiveness of the treatment, for benefiting more patients with pituitary adenomas and related diseases.
ObjectiveTo investigate the risk of cardiac valve regurgitation in patients with pituitary prolactinoma treated with bromocriptine for a long time. MethodsBetween January 2012 and February 2013, 26 pituitary prolactinoma patients treated with bromocriptine for at least 6 months were included in the observation group, and 101 healthy people were regarded as the control group. Transthoracic echocardiography were performed on these patients for cardiac regurgitation, and the echocardiographic data were compared between the two groups. ResultsTrace tricuspid regurgitation was presented in 38.46% of patients in the observation group, and 19.80% of the controls (P=0.046). Interventricular septum thickness was (8.62±0.31) mm in patients in the observation group, and it was (8.57±0.12) mm in the controls (P=0.042). ConclusionNo clinical significant cardiac valve regurgitation has been observed in pituitary prolactinoma patients treated by bromocriptin for a long time. Long-term echocardiographic follow-up of these patients is necessary.
目的:对照研究Fascin在侵袭性和非侵袭性垂体瘤中的表达差异,探讨Fascin的表达与垂体瘤侵袭性的关系。方法:应用Envision二步免疫组化方法,通过测定各样本平均光密度值和积分光密度值,比较侵袭性和非侵袭性垂体腺瘤、不同病理类型、不同体积肿瘤中Fascin的表达差异。结果:Fascin在侵袭性垂体腺瘤的表达明显高于非侵袭性垂体腺瘤,其表达水平与垂体腺瘤的侵袭性正相关,巨大型肿瘤的表达明显高于小型肿瘤,不同病理类型之间无显著差异。结论:Fascin的表达与垂体腺瘤的侵袭生长有关,与垂体瘤大小有关,与病理类型无关。
摘要:目的:研究垂体瘤转化基因在非小细胞肺癌组织、肺良性病变组织和正常支气管黏膜上皮组织中的表达, 初步探讨其与非小细胞肺癌发生发展,侵袭转移的关系。方法:(1)用SP免疫组化法检测76例临床石蜡组织标本(44例非小细胞肺癌、20例肺良性病变组织和12例正常支气管黏膜上皮组织)中的PTTG蛋白的表达。(2)用RTPCR法分析PTTG mRNA在不同性质肺组织中的表达情况。〖HTH〗结果〖HTSS〗:(1)PTTG蛋白在不同性质肺组织中的表达差别具有明显差异;在TNM分期、淋巴结转移组间差别有统计学意义。(2)PTTG mRNA在不同性质肺组织中的表达差别具有明显差异(Plt;0.001);在TNM分期、淋巴结转移组间差别有统计学意义。结论：细胞肺癌的发生发展及转移有关。Abstract: Objective: To investigate the association between PTTG expression and biological behaviors of human nonsmall cell lung cancer (NSCLC).Methods:SP immunohistochemistry was used to detect the expression of PTTG in 76 cases of paraffinembedded specimens (including 44 surgical specimens from NSCLC patients, 20 pneumonic benign lesion and 19 normal bronchial epithelium).Realtime RTPCR was performed to detect PTTGm RNA expression in 44 cases of fresh carcinoma and corresponding adjacent normal mucosa specimens.Results: The expression levels of PTTG was significantly different between normal mucosa and adenoma tissues.There were statistical relationships between their expressions and TNM stage, lymphnode metastasis. Conclusion: PTTG may play an important role in carcinogenesis、development and metastasis of human nonsmall cell lung cancer.
ObjectiveTo explore the effectiveness of the usage of artificial bone of tricalcium phophate in sellar floor reconstruction after transsphenoidal microsurgery for pituitary adeoma. MethodsBetween January and December 2014, 85 patients with pituitary adema underwent transsphenoidal microsurgery, and the clinical data were retrospectively analyzed. "Sandiwich" was used for sellar floor reconstruction in 46 cases (control group), and "sandiwich" combined with the artificial bone of tricalcium phophate in 39 cases (trial group). There was no significant difference in gender, age, disease duration, size of tumor, invasiveness, and the degree of damage to the sellar floor between 2 groups (P>0.05). ResultsTotal removal and subtotal removal of tumors were achieved in 39 cases and 7 cases of the control group, and in 33 cases and 6 cases of the trial group, showing no significant difference between 2 groups (Z=-1.303, P=0.193). Cerebrospinal leakage occurred in 8 cases of the control group and in 10 cases of the trial group during operation, showing no significant difference (Z=-1.748, P=0.080). The case number of cerebrospinal leakage in the control group (4 cases) was significantly more than that in the trial group (0) after operation (P=0.020). The time of gauze removal in the trial group (3 days) was significant shorter than that in the control group[(4.3±1.6) days] (t=2.236, P=0.033). The patients were followed up 3-14 months in the control group and 5-13 months in the trial group. No cerebrospinal leakage occurred during follow-up. ConclusionSellar floor reconstruction with artificial bone of tricalcium phophate is safe, and it can reduce cerebrospinal leakage and shorten the time of gauze removal.
【摘要】 目的 分析手术治疗垂体瘤患者长期临床恢复以及生活质量改善情况。 方法 回顾性分析2007年12月-2008年9月手术治疗的103例垂体瘤患者术前以及术后长期随访资料，使用SF-36量表对术前、术后患者生活质量进行评估，分析手术治疗前后患者症状、激素水平恢复情况以及生活质量改善情况，并进一步分析肿瘤大小、侵袭程度对术后生活质量的影响。 结果 术后头痛症状消失52例，视力改善76例，其他症状具有不同程度改善；术后SF-36生活质量评估结果显示，患者除精神健康外的7个维度（生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能）均有明显改善（P＜0.05），不同肿瘤大小及侵袭程度的患者术后生活质量评分均无统计学意义（P＞0.05），垂体功能完全恢复者生活质量评分高于垂体功能低下者（P＜0.05）。 结论 显微手术治疗垂体瘤患者可明显改善患者的一般症状、提高患者的生活质量，单纯肿瘤的大小和侵袭程度对术后生活质量的影响程度较小，术后垂体功能的恢复程度明显影响患者的生活质量，垂体瘤术后患者的激素长期替代治疗尚需进一步加强。【Abstract】 Objective To analyze the long-term clinical recovery and quality of life (QoL) in patients with pituitary adenoma treated by microneurosurgery. Methods The clinical data of 103 patients undergoing microneurosurgery from December 2007 to September 2008 were retrospectively analyzed, health-related questionnairs (SF-36) were used to assess the QoL. The post-surgery recovery of symptoms, endocrine function, and QoL were compared with those of pre-surgery, then the correlation between tumor size, invasive behavior, and QoL were analyzed. Results Headache disappeared in 52 patients. Visual symptoms improved in 76 patients. Other symptoms were also improved. Seven concepts (physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotioning) were improved after surgery (Plt;0.05). The eight health concepts of SF-36 showed no significant difference between patients with different tumor size and invasive behavior (Pgt;0.05). Differences were considered statistically significant between normal and abnormal pituitary function groups after surgery(Plt;0.05) in all concepts. Conclusion Microneurosurgical treatment can improve the general symptoms and the QoL. The tumor size and invasion have little influence on the QoL after surgery, but the improvement of hormone deficiency has influence on the QoL significantly. More attention should be given to the long-term hormone replacement therapy after the pituitary adenoma surgery.