顱咽管瘤患者手術(shù)前后激素變化經(jīng)驗分析
發(fā)布時間：2019-06-24 11:16
【摘要】：在本論文的簡要概述本組患者的年齡、性別分布、復(fù)發(fā)模式和激素變化,以往的報道側(cè)重于患者癥狀而忽視它的實際比率,我們的研究更注重患者激素波動和內(nèi)分泌疾病。盡管組織學(xué)低度惡性,長期隨訪和并發(fā)癥的處理具有挑戰(zhàn)性。臨床癥狀包括腫瘤在鞍旁生長導(dǎo)致繼發(fā)于顱內(nèi)壓增高,腦積水,或壓迫中樞神經(jīng)系統(tǒng)的重要結(jié)構(gòu),引起頭痛,惡心,視力模糊,以及多尿和煩渴。它是眾所周知,顱咽管瘤通常導(dǎo)致內(nèi)分泌異常由于其起源部位同下丘腦之間關(guān)系密切。 由于腫瘤對下丘腦結(jié)構(gòu)的破壞及各種內(nèi)分泌失常的治療反過來對患者的生活質(zhì)量產(chǎn)生影響。大多數(shù)患者(85-95%)遭受多種下丘腦-垂體功能缺陷,包括完成垂體功能不全,而術(shù)前缺乏激素全面恢復(fù)只發(fā)生在極少數(shù)情況下,生長激素替代療法是治療生長激素缺乏一個被證實的有效、安全的治療方案。然而,腫瘤對下丘腦結(jié)構(gòu)的破壞和或其治療的紊亂被認(rèn)為是貪食和肥胖主要的致病原因,下丘腦損傷程度和后遺癥由影像學(xué)評估。無論初始手術(shù)治療與手術(shù)和／或放射治療,在隨訪的過程中內(nèi)分泌及代謝紊亂更加明顯。而術(shù)前缺乏激素全面恢復(fù)只發(fā)生在極少數(shù)情況下。通過單變量分析,神經(jīng)、血管和視覺并發(fā)癥和患者術(shù)后內(nèi)分泌病變相關(guān),而和患者年齡關(guān)系不明顯。 因此,為了減少內(nèi)分泌對患者的影響,我們對患者的內(nèi)分泌情況進行研究。 目的 ·分析術(shù)前和術(shù)后顱咽管瘤患者垂體前葉激素的變化。 ·觀察平均年齡,性別比例,甲狀腺功能減退癥在研究樣本中的頻率。 ·要查看哪些激素對術(shù)后患者的整體內(nèi)分泌不足的比例最大,并幫助采取必要的措施,在未來患者進一步管理中以盡量減少其影響。 ·檢討生長激素在成人顱咽管瘤病人在我們的研究結(jié)果。 方法和材料 (一)研究人群/納入標(biāo)準(zhǔn)： 年齡18年 手術(shù)類型：腫瘤整體全切除手術(shù)。 手術(shù)方式：額外側(cè)入路 單人操作,以減少外科醫(yī)生的手術(shù)技術(shù)偏見。 (二)研究設(shè)計： 在環(huán)湖醫(yī)院2008至2013年手術(shù)治療的34例成人患者的病歷資料進行回顧性研究。 學(xué)習(xí)的參考值是按照環(huán)湖醫(yī)院實驗室。 T3:1.3-3.1nmol/L T4:66-181nmol/L TSH:0.27-4.2UIU/毫升 GH：0.06-5.0納克/毫升 PRL：2.5-17納克/毫升 LH:0.8-7.6MIU/毫升 ADH：2.2-14皮克/毫升 促腎上腺皮質(zhì)激素：0-46皮克/毫升 COR：5-25微克/分升 FSH:0.7-11.7mIU/L 數(shù)據(jù)采用統(tǒng)計軟件包社會科學(xué)(SPSS軟件版本17.0)進行統(tǒng)計學(xué)分析。使用非 參數(shù)2依賴性樣品測試(Wilcoxon符號秩檢驗)統(tǒng)計顯著性進行了評估。數(shù)據(jù)以0.05為檢驗標(biāo)準(zhǔn)。 結(jié)果 1.平均年齡及病人的標(biāo)準(zhǔn)偏差納入本研究分別為(47.11±1.2)歲,平均50歲。 2.女性與男性的比例,在我們的研究為1：1.3 3.甲狀腺激素的手術(shù)前和手術(shù)后激素狀態(tài)如下：手術(shù)前T3,T4, TSH的血漿平均水平分別為2.41nmol/L,48.99nmol/L,2.05uIU/ml,術(shù)后T3.T4.TSH分別為1.73nmol/L,23.47nmol/L和0.16UIU/ml。 4.有其他垂體前葉激素水平如下：手術(shù)前后LH血漿平均水平分別為3.35MIU/ml和1.78MIU/ml時,泌乳素分別為24.04ng/mL和18.59ng/ml,促腎上腺 皮質(zhì)激素和生長激素均為是0.372ng/ml和0.34ng/ml,腎上腺皮質(zhì)激素分別為15.81微克／分升和8.30微克／毫升,FSH分別為是8.94MIU/L和4.87MIU/L.5.T3.T4.TSH.GRH.FSH.LH手術(shù)前后的平均血漿值有顯著差異,PRL手術(shù)前后激素平均值的差異不明顯。 討論：手術(shù)前內(nèi)分泌疾病常見于顱咽管瘤患者。臨床特征可能不是很明顯,細(xì)致的手術(shù)前的內(nèi)分泌評估是必不可少的。未能認(rèn)識到并解決手術(shù)前尿崩癥和繼受任何手術(shù)治療后會使內(nèi)分泌功能障礙進一步惡化。研究顯示,激素功能障礙的下降趨勢。預(yù)言這個趨勢可以很容易,但要知道激素的模式也是必不可少的。不是所有的激素均往下掉。我們研究了單個激素,得到了各激素的術(shù)前和術(shù)后的比例。 甲狀腺功能和促甲狀腺激素：我們對甲狀腺激素的研究和以往文獻(xiàn)盡管有所不同；甲狀腺功能減退癥總體發(fā)生率在手術(shù)前后分別為61%和73.5%(P0.01)。Honegger等人報道,甲狀腺功能減退癥手術(shù)前后的發(fā)病率分別為24.5%和38.5%,均較我們的研究要低得多。其結(jié)果是基于T3和T4手術(shù)后三個月的測量,但我們的結(jié)果是根據(jù)手術(shù)后一周測量。兩項研究之間的時間間隔可能有助于解釋他們的區(qū)別。另一項研究中甲狀腺功能減退癥在手術(shù)前后的發(fā)病率分別70%和95%,較我們的研究高,這項研究表明,甲狀腺素應(yīng)全部切除顱咽管瘤術(shù)后常規(guī)服用。 我們的結(jié)果發(fā)現(xiàn)TSH是最常見的激素缺乏類型,LH激素缺乏緊隨其后。甲狀腺激素是最常見的激素功能不全,術(shù)前可見于34例患者中的21例；術(shù)后可見于34例患者中的25例。LH激素功能障礙見于術(shù)前的22例和術(shù)后的18例患者。PRL和LH激素缺乏比例在術(shù)后發(fā)生下降。認(rèn)真的手術(shù)前后內(nèi)分泌評估是必須的。因此,認(rèn)識每個患者個別激素的功能減退的趨勢是非常重要的。該激素軸與疾病的解剖方面和治療過程的復(fù)雜性要求進一步深入擴大樣本的前瞻性研究。 結(jié)論 ·激素缺乏似乎是手術(shù)的常見并發(fā)癥。 ·TSH、COR和LH激素缺乏的發(fā)生更頻繁。 ·甲狀腺素和糖皮質(zhì)激素應(yīng)作為顱咽管瘤全部切除術(shù)后常規(guī)處理。 ·我們相信,通過我們的研究和各激素的分析,可以有助于對內(nèi)分泌失調(diào)的理解。 ·這項研究可以作為對這些患者預(yù)期成果的估計,并指導(dǎo)決策和促進此領(lǐng)域進一步的研究
[Abstract]:In this paper, the age, sex distribution, recurrence pattern and hormonal changes of the patients were briefly summarized. The previous report focused on the patient's symptoms and ignored the actual ratio, and our study focused more on the patient's hormone fluctuation and the endocrine disease. Long-term follow-up and complications are challenging, despite the low level of histology. Clinical symptoms include an important structure of a tumor that is secondary to intracranial pressure, hydrocephalus, or compression of the central nervous system, resulting in headache, nausea, blurred vision, and polyuria and thirst, secondary to intracranial pressure increase, hydrocephalus, or compression of the central nervous system. It is well known that craniopharyngioma usually results in an abnormal endocrine disorder due to the close relationship between its origin and the hypothalamus. The destruction of the hypothalamic structure and the treatment of various endocrine disorders, in turn, have a shadow on the quality of life of the patient due to the tumor's destruction of the hypothalamic structure and the treatment In response, most patients (85-95%) suffer from a variety of hypothalamic-pituitary functional deficiencies, including the completion of the pituitary function, and the lack of a full recovery of the hormone prior to the procedure occurs only in rare cases where growth hormone replacement therapy is a proven problem for the treatment of growth hormone deficiency effective and safe treatment party Cases. However, the disruption of the hypothalamic structure and the disorder in the treatment of the tumor are considered to be the main cause of the main cause of the gluttony and obesity, and the extent and the sequelae of the hypothalamic injury are assessed by the imaging Assessment of endocrine and metabolic disorders in the follow-up process, regardless of initial surgical treatment and surgery and/ or radiation therapy The absence of a full recovery of the hormone prior to the operation occurs only in a very small number of cases The patient's age relationship was unknown by univariate analysis, neurological, vascular and visual complications, and postoperative endocrine changes in the patient. In order to reduce the effect of the endocrine on the patient, the endocrine condition of the patient line-and-study The purpose of this study was to analyze the pituitary of the patients with craniopharyngioma before and after operation. Changes of the previous leaf hormone. 路 observed mean age, sex ratio, hypothyroidism The frequency in the study sample. 路 To see which hormones are the largest proportion of the overall endocrine deficit of the post-operative patient, and to help take the necessary measures to further develop the patient in the future Management to minimize its impact. Review of growth hormone in the cranium of the adult opharyngioma In our research results. Methods and materials (i) Study Population/ Inclusion Criteria: Age:18 years of operation Type: overall total resection of the tumor. Method of operation: amount Lateral approach single person Operation to reduce surgeon's surgical technique bias. (ii) Study design: at the ring-lake hospital,2008- 34 adult patients with surgical treatment in 2013 A retrospective study of the medical records. The reference value of the study is according to the ring lake hospital laboratory . T3:1.3-3.1nmol/ L T4:66-181nmol /L TSH:0.27-4. 2 UIU/ ml GH: 0.06 -5.0 ng/ ml PRL: 2.5-17 ng/ ml LH:0. 8-7.6 MIU/ ml ADH: 2.2 -14pg/ ml Corticotropin:0-46 pg/ ml COR:5-25 ug/ L FSH : 0.7-11.7 mIU/ L data with statistical software package social science (SPSS software Version 17.0) for statistical analysis Analysis. The statistical significance of the Wilcoxon signed-rank test was assessed using a non-parametric 2-dependent sample test (Wilcoxon signed-rank test). The data is the test standard at 0.05. Result 1. Average The mean age and the standard deviation of the patient were (47.11-1.2) years, with an average of 50 years.2. The proportion of women to men was 1: 1.3. The pre-operative and post-operative hormone levels of thyroid hormones were as follows: the plasma average of T3, T4, and TSH before operation was 2.41 nmol/ L, 48.99 nm, respectively. The thyroid hormone levels were 1.73 nmol/ L, 23.47 nmol/ L and 0.16 UIU/ ml, respectively. The LH plasma average was 3.35 MIU/ ml and 1.78 MIU/ ml, respectively, and the prolactin was 24.04 ng/ mL and 18.59 ng/ ml, respectively. The adrenocortical hormone and the growth hormone were 0.372 ng/ ml and 0.34 ng/ ml, and the adrenocortical hormone was 15.81 ug/ ml and 8.30 ug/ ml, respectively, and the FSH was 8.94 MIU/ L, respectively. and 4.87 MIU/ L. 5.T3. T4. TS The mean plasma values before and after the H. GRH. FSH. LH procedure were significantly different, and the PRL There was no significant difference in the mean value of the hormone before and after operation. The pre-operative endocrine disease was common in the patients with craniopharyngioma. The clinical feature may not be a very clear and detailed procedure The pre-operative endocrine assessment is essential. Failure to recognize and address pre-operative diabetes insipidus and in that course of any surgical treatment, A further deterioration in the secretion of secretion. Studies have shown that the decline in hormone dysfunction The trend. It's easy to predict this trend, but it's essential to know the pattern of hormones. Not all of the hormones are down. We have studied a single hormone to get the pre-and post-operative proportions of each hormone. Thyroid function and thyroid stimulating hormone: we The study of thyroid hormone and the previous literature were different; the overall incidence of hypothyroidism was 6 before and after operation 1% and 73.5% (P0.01). Honeger et al. reported that the function of hypothyroidism The incidence of pre-and post-operative morbidity was 24.5% and 38.5%, respectively. Our study was much lower. The results were measured three months after the operation of T3 and T4, but our results were measured one week after the operation. The interval between the two studies may help to explain them. The difference was that the incidence of hypothyroidism in the other study was 70% before and after the operation, respectively. 95%, higher than our study, this study shows that thyroxine should be taken in all of the patients with craniopharyngioma. Our results show that T SH is the most common type of hormone deficiency, and the LH hormone deficiency is followed. The thyroid gland hormone is the most common hormone insufficiency, and can be seen before operation. 21 of 34 patients; postoperative visual Of the 34 patients,25 of the 34 patients. LH hormone dysfunction was found in 22 pre-operative and The proportion of PRL and LH in 18 patients was decreased after operation. Assessment It is necessary. Therefore, it is recognized that each patient is individually excited The tendency to reduce the function of the hormone is very important. The hormone axis and disease The anatomy of the disease and the complexity of the treatment process require further in-depth enlargement of the sample's forward-looking Sex study. Conclusion: The lack of hormone appears to be a common complication of the operation. The occurrence of R and LH hormone deficiency is more frequent.
【學(xué)位授予單位】：天津醫(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：2505016
[Abstract]:In this paper, the age, sex distribution, recurrence pattern and hormonal changes of the patients were briefly summarized. The previous report focused on the patient's symptoms and ignored the actual ratio, and our study focused more on the patient's hormone fluctuation and the endocrine disease. Long-term follow-up and complications are challenging, despite the low level of histology. Clinical symptoms include an important structure of a tumor that is secondary to intracranial pressure, hydrocephalus, or compression of the central nervous system, resulting in headache, nausea, blurred vision, and polyuria and thirst, secondary to intracranial pressure increase, hydrocephalus, or compression of the central nervous system. It is well known that craniopharyngioma usually results in an abnormal endocrine disorder due to the close relationship between its origin and the hypothalamus. The destruction of the hypothalamic structure and the treatment of various endocrine disorders, in turn, have a shadow on the quality of life of the patient due to the tumor's destruction of the hypothalamic structure and the treatment In response, most patients (85-95%) suffer from a variety of hypothalamic-pituitary functional deficiencies, including the completion of the pituitary function, and the lack of a full recovery of the hormone prior to the procedure occurs only in rare cases where growth hormone replacement therapy is a proven problem for the treatment of growth hormone deficiency effective and safe treatment party Cases. However, the disruption of the hypothalamic structure and the disorder in the treatment of the tumor are considered to be the main cause of the main cause of the gluttony and obesity, and the extent and the sequelae of the hypothalamic injury are assessed by the imaging Assessment of endocrine and metabolic disorders in the follow-up process, regardless of initial surgical treatment and surgery and/ or radiation therapy The absence of a full recovery of the hormone prior to the operation occurs only in a very small number of cases The patient's age relationship was unknown by univariate analysis, neurological, vascular and visual complications, and postoperative endocrine changes in the patient. In order to reduce the effect of the endocrine on the patient, the endocrine condition of the patient line-and-study The purpose of this study was to analyze the pituitary of the patients with craniopharyngioma before and after operation. Changes of the previous leaf hormone. 路 observed mean age, sex ratio, hypothyroidism The frequency in the study sample. 路 To see which hormones are the largest proportion of the overall endocrine deficit of the post-operative patient, and to help take the necessary measures to further develop the patient in the future Management to minimize its impact. Review of growth hormone in the cranium of the adult opharyngioma In our research results. Methods and materials (i) Study Population/ Inclusion Criteria: Age:18 years of operation Type: overall total resection of the tumor. Method of operation: amount Lateral approach single person Operation to reduce surgeon's surgical technique bias. (ii) Study design: at the ring-lake hospital,2008- 34 adult patients with surgical treatment in 2013 A retrospective study of the medical records. The reference value of the study is according to the ring lake hospital laboratory . T3:1.3-3.1nmol/ L T4:66-181nmol /L TSH:0.27-4. 2 UIU/ ml GH: 0.06 -5.0 ng/ ml PRL: 2.5-17 ng/ ml LH:0. 8-7.6 MIU/ ml ADH: 2.2 -14pg/ ml Corticotropin:0-46 pg/ ml COR:5-25 ug/ L FSH : 0.7-11.7 mIU/ L data with statistical software package social science (SPSS software Version 17.0) for statistical analysis Analysis. The statistical significance of the Wilcoxon signed-rank test was assessed using a non-parametric 2-dependent sample test (Wilcoxon signed-rank test). The data is the test standard at 0.05. Result 1. Average The mean age and the standard deviation of the patient were (47.11-1.2) years, with an average of 50 years.2. The proportion of women to men was 1: 1.3. The pre-operative and post-operative hormone levels of thyroid hormones were as follows: the plasma average of T3, T4, and TSH before operation was 2.41 nmol/ L, 48.99 nm, respectively. The thyroid hormone levels were 1.73 nmol/ L, 23.47 nmol/ L and 0.16 UIU/ ml, respectively. The LH plasma average was 3.35 MIU/ ml and 1.78 MIU/ ml, respectively, and the prolactin was 24.04 ng/ mL and 18.59 ng/ ml, respectively. The adrenocortical hormone and the growth hormone were 0.372 ng/ ml and 0.34 ng/ ml, and the adrenocortical hormone was 15.81 ug/ ml and 8.30 ug/ ml, respectively, and the FSH was 8.94 MIU/ L, respectively. and 4.87 MIU/ L. 5.T3. T4. TS The mean plasma values before and after the H. GRH. FSH. LH procedure were significantly different, and the PRL There was no significant difference in the mean value of the hormone before and after operation. The pre-operative endocrine disease was common in the patients with craniopharyngioma. The clinical feature may not be a very clear and detailed procedure The pre-operative endocrine assessment is essential. Failure to recognize and address pre-operative diabetes insipidus and in that course of any surgical treatment, A further deterioration in the secretion of secretion. Studies have shown that the decline in hormone dysfunction The trend. It's easy to predict this trend, but it's essential to know the pattern of hormones. Not all of the hormones are down. We have studied a single hormone to get the pre-and post-operative proportions of each hormone. Thyroid function and thyroid stimulating hormone: we The study of thyroid hormone and the previous literature were different; the overall incidence of hypothyroidism was 6 before and after operation 1% and 73.5% (P0.01). Honeger et al. reported that the function of hypothyroidism The incidence of pre-and post-operative morbidity was 24.5% and 38.5%, respectively. Our study was much lower. The results were measured three months after the operation of T3 and T4, but our results were measured one week after the operation. The interval between the two studies may help to explain them. The difference was that the incidence of hypothyroidism in the other study was 70% before and after the operation, respectively. 95%, higher than our study, this study shows that thyroxine should be taken in all of the patients with craniopharyngioma. Our results show that T SH is the most common type of hormone deficiency, and the LH hormone deficiency is followed. The thyroid gland hormone is the most common hormone insufficiency, and can be seen before operation. 21 of 34 patients; postoperative visual Of the 34 patients,25 of the 34 patients. LH hormone dysfunction was found in 22 pre-operative and The proportion of PRL and LH in 18 patients was decreased after operation. Assessment It is necessary. Therefore, it is recognized that each patient is individually excited The tendency to reduce the function of the hormone is very important. The hormone axis and disease The anatomy of the disease and the complexity of the treatment process require further in-depth enlargement of the sample's forward-looking Sex study. Conclusion: The lack of hormone appears to be a common complication of the operation. The occurrence of R and LH hormone deficiency is more frequent.
【學(xué)位授予單位】：天津醫(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(xiàn)】
相關(guān)期刊論文 前2條
1 ;Microsurgical treatment of craniopharyngiomas:report of 284 patients[J];Chinese Medical Journal;2006年19期
2 周忠清,石祥恩;Changes of hypothalamus-pituitary hormones in patients after totalr emoval of craniopharyngiomas[J];Chinese Medical Journal;2004年03期
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