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目的分析经蝶窦入路切除的侵袭性垂体腺瘤的组织学侵袭性与临床预后的关系。方法我科自2000年1月-2003年5月行经蝶手术切除的具有完整影像学、病理学和随访资料的侵袭性垂体腺瘤82例,其中PRL 腺瘤39例,GH腺瘤13例,ACTH腺瘤6例,无功能腺瘤24例,随访时间5-30个月。结果侵袭性垂体腺瘤MRI影像学特点为鞍底受侵下陷,部分肿瘤突入蝶窦;颈内动脉包绕;海绵窦受累,鞍隔突破等,病理检查以鞍底硬膜浸润的发生率最高,并有20例(24.4%)发现有肿瘤内卒中或出血。PRL腺瘤的全切率明显低于无功能腺瘤(P<0.01), 而无功能腺瘤、GH腺瘤与AcTH腺瘤之间相差不明显。PRL腺瘤的复发率较无功能腺瘤和GH腺瘤高(P<0.05)。结论侵袭性垂体腺瘤中,无功能腺瘤与GH腺瘤的治疗效果优于PRL腺瘤,垂体腺瘤的侵袭性生物学行为导致手术全切机率下降,是术后复发的丰要原因。
Objective To analyze the relationship between histological invasion and clinical prognosis of invasive pituitary adenomas resected by transsphenoidal approach. Methods 82 cases of invasive pituitary adenomas with complete imaging, pathology and follow-up data from January 2000 to May 2003 in our department were excised, including 39 cases of PRL adenoma, 13 cases of GH adenoma, ACTH adenoma in 6 cases, 24 cases of non-functioning adenomas, followed up for 5-30 months. Results The MRI findings of invasive pituitary adenomas were subsidence of the sella at the base of the sella, some of the tumors protruding into the sphenoid sinus, the internal carotid artery, the cavernous sinus involvement and the septal defect. Pathological examination showed the highest incidence of sella infiltrates , And 20 cases (24.4%) found tumor strokes or bleeding. The total resection rate of PRL adenoma was significantly lower than that of non-functional adenoma (P <0.01), but there was no significant difference between non-functioning adenoma, GH adenoma and AcTH adenoma. The recurrence rate of PRL adenoma was higher than that of non-functioning adenoma and GH adenoma (P <0.05). Conclusions In invasive pituitary adenomas, the treatment effect of non-functioning adenoma and GH adenoma is better than that of PRL adenoma. The invasive biological behavior of pituitary adenoma results in the reduction of the rate of total surgical resection, which is a major cause of postoperative recurrence.