頁籤選單縮合
題名 | Follow-up of Invasive Pituitary Macroadenoma in 56 Patients within a Duration of 5 Years=56位侵犯性腦垂腺腫瘤患者5年追蹤結果報告 |
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作者 | 張志任; 黃幼慧; 洪純隆; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷期 | 16:7 2000.07[民89.07] |
頁次 | 頁339-344 |
分類號 | 416.291 |
關鍵詞 | 侵犯性腦垂腺腫瘤; Invasive; Macroadenoma; Pituitary apoplexy; |
語文 | 英文(English) |
中文摘要 | 腦垂腺腫瘤一般來說,屬於良性腺瘤。在腦垂腺腫瘤中,少數的患者 中,腫瘤表現方式類似惡性腫瘤,以侵犯土耳其鞍,第三腦室侵犯甚至於其它地 方的轉移。但在病理檢查下為良性腫瘤,在定義上為侵犯性腦垂腺腫瘤。再過去 十年中,我們收集了188位罹患腦垂腺腫瘤的患者中,有56位經放射診斷及 手術診斷為侵犯性腦垂腺腫瘤。在這56位患者中,21位有泌乳素瘤,8位為生 長激素瘤,27位為無功能性腺瘤。27位為女性,29位為男性。在腫瘤的大小上, 8位為巨大腺瘤併局部土耳其鞍侵蝕及第三腦室偏離;18位為併有顱骨內及硬腦 膜內生長;22位為併有海綿竇侵犯。治療上,51位接受經蝶竇腦垂腺腫瘤摘除 手術;1位接受下顎骨腦垂腺腫瘤摘除手術;4位接受兩種腦垂腺腫瘤摘除手術。 50位患者在術後,接受高劑量放射治療及內分泌治療;在泌乳素瘤患者,則給 予bromocriptin使用。在過去5年的追蹤下,大部分的患者,視野及生活品質在 術後都有改善。因為腫瘤生長方式造成手術治療上的盲點及限制,侵犯性腦垂腺 腫瘤往往無法以手術完全摘除。必須加上賀爾蒙治療及高劑量放射治療。可惜的 是復發率偏高。在我們的研究中,在5年內症狀復發或血中賀爾蒙升高的患者約 有20位佔百分之三十五。好復發於生長激素留及泌乳素瘤患者泌乳素高於 200ηg/dl的患者。 |
英文摘要 | From June 1986 to September 1996,56(30%)patients with invasive pituitary macroadenoma were studied retrospectively.We compared the clinical and endocrinological characteristics,neuroimagind findings,and surgical outcome of these patients in a period of follow up of 5 years.Twenty-one patients(38%) were found to have a prolactinoma,8 patients (14%) had a GH-producing adenoma,and 27 patients (48%) fad non-functional tumors. Pituitary apoplexy was found in16cases(29%).Their age ranged from 15 to 72 years and no sex difference(F:M=27:29) was found .According to Hardy's classification,all the 56 tumors were invasive pituitary macroadenoma,of a tumor size more than 10 mm with sellar floor erosion partially or diffusely or paracarvenous sinus invasion .Those tumors were divided intio grade III(tumor causing localized perforation of the sellar floor),and IV(tumor destroying entire sellar floor diffusely);the tumors were further subdivided into stage C(3 rd ventricle grossly displace),D(intracranial intradural extension )and E (tumors invading the cavernous sinus through the lateral dural envelope of the sellar ).Eight out of 56 tumors belonged to grade III stage C ,18 tumors were grade III stage D,8 tumors were grade IV stage D,and the other 22 were grade IV stage E. Fifty-one patients received transsphemoidal craniectomy for tumor removal, one patient tooksubfrontal craniotomy only and 4 cases received both. Most patients improved significantly in visual field and general quality of life after surgery. In this study, it was concluded that: 1)surgical intervention as quick as possible was proven advantageous, especially in patients with an invasive macroadenoma; 2) in cases with invasive pituitary macroadenomas, the patients, with grade III and IV tumors, had a longer symptom-free interval than those who refused surgical intervention and radiotherapy with the same grade tumor; 3) to achieve satisfactory late reults, multidisciplinary treatment was necessary:post-operative radiotherapy ranging from 4500 to 6500 rads was done in 50 patients, endocrine therapy in 52 patients and adjunct bromocriptine treatment was done in 13 patients with prolactinomas; 4)symptomatic recurrence or elevated postoperative hormone levels occurred in 20(35%) cases. There was a high incidence of recurrence in 6(6/20) GH-secreting tumors, and in 8(8/20) prolactinomas with preoperative prolactin levels more than 200ug/dl. |
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