ObjectiveTo explore the value of bilateral inferior petrosal sinus sampling (BIPSS) for preoperative diagnosis of adrenocorticotropic hormone (ACTH) microadenomas.MethodsWe retrospectively analyzed the clinical date of patients with ACTH microadenomas, who were experienced BIPSS preoperatively from October 2013 to May 2017. The qualitative and localized diagnostic significance of BIPSS was evaluated based on the criteria of the plasma ACTH concentration ratio of inferior petrosal sinus to ulnar vein (≥2), and the ratio of left to right inferior petrosal sinuses (≥1.4).ResultsFive patients (1 male and 4 females) were involved in the study. The mean age was (49.6±9.2) years, and the mean disease course was (17.2±7.5) months. The plasma ACTH concentration of all the cases ran up to the criterition of the ratio of inferior petrosal sinus to ulnar vein (≥2). Three cases were found that the actual locations of the microadenomas were inconsistent with the indications from the results of BIPSS. After the BIPSS procedure, there was no intracranial infection or death case, except that one patient suffered from ecchymoma and another one suffered from transient nausea.ConclusionBIPSS is valuable for qualitative diagnosis, but not effective for localization diagnosis of the ACTH microadenomas preoperatively.
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。
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.
Objective To study the methods and techniques of the treatment forextensive suprasellar pituitary adenona and repairing hole.Methods From Feb. 2001 to Mar. 2003, 9 patients with exrensive suporasellar pituitary adenoma underwent resection via suprabital keyhole with endoscope-assisted microneurosurgery. Then the remaining tumor was removed with neuroendoscope via Ⅰand Ⅱ space of optic chiasma. The small bone flap was fixed with Ti clamp. Results After the tumor was removed with microneurosurgery, the remaining tumor was still found with endoscope in 7 cases. Remaining tumor was totally removed in 6 cases, almost removed in 3 cases. The vision improvement was found in 7 cases one week after surgery. In the other 2 cases, the vision remained unchanged. Follow-up was conducted in 6 cases for 6 to 22 months. Neuroradiological recovery of MRI with no recurrence of tumor was observed. No complication of incision was present. Conclusion Enough intra and extra-cranial space can be provided to operate via orbital roof approach to sellar tumors. Endoscope-assisted microneurosurgery can increase the total-resection and successful rate treatment for extensive suprasellar pituitary adenoma, reduce the possibility of complication, and pretect the function of brain from being injured. Fixation of small bone flap with Ti clamp is safe, easy and reliable.
【摘要】 目的 探讨伽玛刀治疗垂体腺瘤远期肿瘤控制及并发症发生情况。 方法 2004年6月-2006年12月共158例垂体腺瘤患者接受伽玛刀治疗。伽玛刀治疗边缘剂量12～30 Gy，以45%~70%等剂量曲线覆盖肿瘤灶。术后定期对患者进行门诊随访和鞍区增强MRI扫描，记录肿瘤控制及并发症发生情况。 结果 131例患者完成随访，平均随访时间49个月。至随访结束，共7例患者肿瘤增大复发。伽玛刀治疗后1、2、3、4及5年肿瘤控制率分别为95.8%、95.8%、95.8%、95.8%及93.9%。46例患者（35.1%）在治疗后出现暂时性头痛和感觉异常，对症处理后缓解；4例患者（3.1%）出现垂体功能低下，接受激素替代治疗。未观察到其他颅神经和血管损害表现。 结论 伽玛刀治疗垂体瘤远期疗效肯定，并发症轻微，是一种安全可靠的垂体瘤治疗手段。【Abstract】 Objective To explore the long-term tumor control and side effects of gamma knife treatment for pituitary adenoma. Methods One hundred and fifty-eight patients with pituitary adenoma undergone gamma knife treatment were periodically followed up from June 2004 to December 2006. The prescript radiation dosage was 12-30 Gy. An enhanced MRI scan was scheduled every 6-12 months after the treatment. The tumor sizes of different scan were compared and the side effects were recorded. Results One hundred and thirty-one patients finished the follow-up procedure with an average time of 49 months. One hundred and twenty-four patients received good tumor control at the end of the research and recurrence was seen in seven patients. The 1-, 2-, 3-, 4-, and 5- year tumor control rates were 95.8%, 95.8%, 95.8%, 95.8%, and 93.9% respectively. Forty-six patients showed temporal and were relieved after treatment. Hypopituitarism was seen in four patients but no cranial nerve or vascular damage was detected. Conclusion The long-term effect of gamma knife therapy for pituitary adenoma remains good and the incidence of side effects is low. Gamma knife therapy could be a safe and effective choice for pituitary adenoma treatment.
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.
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.
Objective To analyze the central visual fields and the ocular fundus changes of both eyes of patients with pituitary adenoma.Methods A total of 70 cases of pituitary adenoma received the examination of static central visual fields of all-liminal values by Humphrey instruments 750 cycloscope and the fundus exams by Topcon TRC-50X fundus photography before operations. Results There were 64.3% patients with decreased visual acuities, 80.7% with the defect of visual field, and 46 .4% with fundus changes. The decrease of the visual acuity was the first diagnostic symptom in 45.7% patients, among whom 28.6% were misdiagnosed as ocular diseases.Conclusions The misdiagnosed cause is that the first diagnostic symptom is the decrease of visual acuity without defect of visual field accompanied by ocular diseases. To avoid the misdiagnosis and the omitter of pituitary adenoma, general examination of visual field should be carried out in the patients with decreased visual acuity and optic atrophy with unknown reason in the clinical diagnosis of ophthalmology. (Chin J Ocul Fundus Dis，2003，19：18-19)
【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.