GH大腺瘤與非GH大腺瘤鞍外生長方式的比較
發(fā)布時間：2019-04-02 18:54
【摘要】：目的：在臨床診療過程中我們發(fā)現(xiàn)垂體腺瘤的病理類型不同，腫瘤的生長方式也有差異。我們的目的是通過對比分析GH垂體大腺瘤與非GH大腺瘤鞍外侵襲的方式，以了解不同病理類型垂體腺瘤鞍外侵襲的差異。 方法：我們回顧性分析了2008年12月至2013年3月間因頭痛、視力視野障礙、面容改變等來北京天壇醫(yī)院行手術(shù)治療的垂體大腺瘤患者，所有患者均于我院行術(shù)前頭顱CT及MRI檢查并經(jīng)術(shù)后病理證實。微腺瘤患者及有手術(shù)史的患者均排除。由此可得生長激素細胞（GH）垂體大腺瘤患者100例，促腎上腺皮質(zhì)激素細胞（ACTH）垂體大腺瘤患者32例，，促卵泡刺激素細胞（FSH）垂體大腺瘤患者53例，促黃體素細胞（LH）垂體大腺瘤患者4例，促甲狀腺素細胞（TSH）垂體大腺瘤患者16例，泌乳素細胞（PRL)垂體大腺瘤患者46例及隨機選取的無功能性腺瘤（NFMAs）患者50例。術(shù)前CT檢測包括軸位、矢狀位及冠狀位薄層掃描，觀察鞍區(qū)形態(tài)，鞍底、前床突及鞍背骨質(zhì)破壞情況。術(shù)前頭部MRI檢測包括鞍區(qū)軸位、矢狀位及冠狀位平掃+增強，了解垂體瘤的大小、形態(tài)、生長方向及與鄰近海綿竇、視交叉等結(jié)構(gòu)的關(guān)系。對比分析GH大腺瘤與非GH大腺瘤及其他病理類型垂體大腺瘤的鞍外生長情況。 結(jié)果：通過對比研究我們可以得出：1、GH大腺瘤患者與非GH大腺瘤患者相比男女比例無明顯差異；2、GH大腺瘤患者初次就診時腫瘤平均最大直徑及平均體積較非GH大腺瘤�。�3、GH大腺瘤患者初次就診的平均年齡較非GH大腺瘤患者小；4、GH大腺瘤較非GH大腺瘤更易向鞍下侵襲，非GH大腺瘤趨向于鞍上生長；5、GH大腺瘤生長方式與非GH大腺瘤的其他病理類型兩兩比較時多數(shù)無明顯統(tǒng)計學(xué)差異；6.GH大腺瘤與FSH大腺瘤和NFMAs大腺瘤相比，P0.001,FSH大腺瘤和NFMAs大腺瘤更易向鞍上生長；當只考慮僅向鞍下生長時，GH大腺瘤較其他兩者更明顯；7、當對比腺瘤自身各生長方向時，我們發(fā)現(xiàn)GH腺瘤、ACTH腺瘤、PRL腺瘤及NFMAs腺瘤更易向鞍下生長；FSH腺瘤較易向鞍下或鞍上生長；LH腺瘤及TSH腺瘤向各方向生長無統(tǒng)計學(xué)差異。 結(jié)論：通過對比研究GH大腺瘤與非GH大腺瘤可知，不同病理類型的垂體大腺瘤鞍外生長具有顯著的特異性。GH腺瘤患者發(fā)病后就診的年齡較非GH腺瘤小，而且腫瘤直徑及體積也較小。盡管體積較小，但是GH大腺瘤較易向鞍下侵襲，而非GH腺瘤體積較大而易向鞍上生長。
[Abstract]:Objective: in the course of clinical diagnosis and treatment, we found different pathological types of pituitary adenomas and different growth patterns of pituitary adenomas. The purpose of this study was to compare the extraSellar invasion of GH pituitary macroadenomas and non-GH large adenomas in order to understand the differences in extraSellar invasion of different pathological types of pituitary adenomas. Methods: from December 2008 to March 2013, we retrospectively analyzed the patients with pituitary macroadenoma who came to Beijing Tiantan Hospital for surgical treatment due to headache, visual field disturbance and face change. All patients were examined by CT and MRI before operation in our hospital and proved by pathology. Patients with microadenomas and patients with a history of surgery were excluded. The results showed that there were 100 patients with (GH) pituitary macroadenoma, 32 patients with (ACTH) hypophyseal macroadenoma, 53 patients with (FSH) pituitary macroadenoma with follicle stimulating hormone cell, and 32 patients with gonadotropin cell (ACTH) pituitary macroadenoma, and 53 patients with gonadotropin cell (FSH) pituitary macroadenoma. There were 4 cases of luteinizing (LH) pituitary macroadenoma, 16 cases of thyrotropin cell (TSH) pituitary macroadenoma, 46 cases of prolactin cell (PRL) pituitary macroadenoma and 50 cases of non-functional adenoma (NFMAs). Preoperative CT examination included axial, sagittal and coronal thin-slice scanning to observe the shape of the Sellar region, the destruction of the Sellar floor, the anterior process of the bed and the back of the Sella. Preoperative MRI of the head included axial, sagittal and coronal plain enhancement of the Sellar region to understand the size, shape, growth direction of pituitary adenoma and its relationship with adjacent cavernous sinus and optic chiasma. The extraSellar growth of GH macroadenomas and non-GH macroadenomas and other pathological types of pituitary macroadenomas was analyzed. Results: (1) there was no significant difference in the ratio of GH greater adenomas between men and women compared with non-GH large adenomas; (2) the mean maximum diameter and average volume of GH large adenomas were smaller than those of non-GH large adenomas at the first visit, and the mean age of GH large adenomas was smaller than that of non-GH large adenomas. (4) GH greater adenomas were more prone to subSellar invasion than non-GH large adenomas, and non-GH large adenomas tended to grow in the suprasellar region, 5. There was no significant difference in the growth patterns between GH large adenomas and other pathological types of non-GH macroadenomas. Compared with FSH macroadenomas and NFMAs macroadenomas, 6.GH macroadenomas and NFMAs macroadenomas are more likely to grow to the suprasellar region, and when only subSellar growth is considered, GH macroadenomas are more obvious than those of the other two adenomas, and P0.001FSH macroadenomas and NFMAs macroadenomas are more likely to grow to the suprasellar region. 7. We found that GH adenomas, ACTH adenomas, PRL adenomas and NFMAs adenomas were more prone to subSellar growth, FSH adenomas were more prone to subSellar or suprasellar growth, and LH adenomas and TSH adenomas were not significantly different from those of TSH adenomas. Conclusion: a comparative study of GH macroadenomas and non-GH macroadenomas shows that the extraSellar growth of different pathological types of pituitary macroadenomas has significant specificity. The age of patients with GH adenomas after onset is younger than that of non-GH adenomas. The diameter and volume of the tumor were also smaller. In spite of its small size, GH adenomas are more likely to invade the subSellar region, while non-GH adenomas are larger in size and easier to grow into the suprasellar region.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.41
本文編號：2452825
[Abstract]:Objective: in the course of clinical diagnosis and treatment, we found different pathological types of pituitary adenomas and different growth patterns of pituitary adenomas. The purpose of this study was to compare the extraSellar invasion of GH pituitary macroadenomas and non-GH large adenomas in order to understand the differences in extraSellar invasion of different pathological types of pituitary adenomas. Methods: from December 2008 to March 2013, we retrospectively analyzed the patients with pituitary macroadenoma who came to Beijing Tiantan Hospital for surgical treatment due to headache, visual field disturbance and face change. All patients were examined by CT and MRI before operation in our hospital and proved by pathology. Patients with microadenomas and patients with a history of surgery were excluded. The results showed that there were 100 patients with (GH) pituitary macroadenoma, 32 patients with (ACTH) hypophyseal macroadenoma, 53 patients with (FSH) pituitary macroadenoma with follicle stimulating hormone cell, and 32 patients with gonadotropin cell (ACTH) pituitary macroadenoma, and 53 patients with gonadotropin cell (FSH) pituitary macroadenoma. There were 4 cases of luteinizing (LH) pituitary macroadenoma, 16 cases of thyrotropin cell (TSH) pituitary macroadenoma, 46 cases of prolactin cell (PRL) pituitary macroadenoma and 50 cases of non-functional adenoma (NFMAs). Preoperative CT examination included axial, sagittal and coronal thin-slice scanning to observe the shape of the Sellar region, the destruction of the Sellar floor, the anterior process of the bed and the back of the Sella. Preoperative MRI of the head included axial, sagittal and coronal plain enhancement of the Sellar region to understand the size, shape, growth direction of pituitary adenoma and its relationship with adjacent cavernous sinus and optic chiasma. The extraSellar growth of GH macroadenomas and non-GH macroadenomas and other pathological types of pituitary macroadenomas was analyzed. Results: (1) there was no significant difference in the ratio of GH greater adenomas between men and women compared with non-GH large adenomas; (2) the mean maximum diameter and average volume of GH large adenomas were smaller than those of non-GH large adenomas at the first visit, and the mean age of GH large adenomas was smaller than that of non-GH large adenomas. (4) GH greater adenomas were more prone to subSellar invasion than non-GH large adenomas, and non-GH large adenomas tended to grow in the suprasellar region, 5. There was no significant difference in the growth patterns between GH large adenomas and other pathological types of non-GH macroadenomas. Compared with FSH macroadenomas and NFMAs macroadenomas, 6.GH macroadenomas and NFMAs macroadenomas are more likely to grow to the suprasellar region, and when only subSellar growth is considered, GH macroadenomas are more obvious than those of the other two adenomas, and P0.001FSH macroadenomas and NFMAs macroadenomas are more likely to grow to the suprasellar region. 7. We found that GH adenomas, ACTH adenomas, PRL adenomas and NFMAs adenomas were more prone to subSellar growth, FSH adenomas were more prone to subSellar or suprasellar growth, and LH adenomas and TSH adenomas were not significantly different from those of TSH adenomas. Conclusion: a comparative study of GH macroadenomas and non-GH macroadenomas shows that the extraSellar growth of different pathological types of pituitary macroadenomas has significant specificity. The age of patients with GH adenomas after onset is younger than that of non-GH adenomas. The diameter and volume of the tumor were also smaller. In spite of its small size, GH adenomas are more likely to invade the subSellar region, while non-GH adenomas are larger in size and easier to grow into the suprasellar region.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.41
【參考文獻】
相關(guān)期刊論文 前1條
1 王欣;張雪君;;垂體生長激素腺瘤的MRI特點[J];天津醫(yī)科大學(xué)學(xué)報;2012年04期
本文編號：2452825
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