本文關(guān)鍵詞： 生長激素型垂體腺瘤 GH IGF-1 TSS 復(fù)發(fā) 殘留 肢端肥大癥　出處：《北京協(xié)和醫(yī)學(xué)院》2015年博士論文　論文類型：學(xué)位論文

【摘要】：目的建立生長激素型垂體腺瘤數(shù)據(jù)庫,整合患者的所有臨床資料為科研提供數(shù)據(jù)基礎(chǔ)。從數(shù)據(jù)庫中選出符合要求的病例資料進行分析。本研究旨在分析2012年初-2015年初通過TSS再次治療的患者的預(yù)后相關(guān)因素,評估TSS再次治療的意義。方法和軟件公司協(xié)作建立生長激素型垂體腺瘤數(shù)據(jù)庫,錄入2012年以來在北京協(xié)和醫(yī)院就診的生長激素型垂體腺瘤患者的臨床資料,并對部分可能在科研中用到的描述性指標(biāo)進行人工識別和錄入。從數(shù)據(jù)庫中查詢2012年初-2014年初在本院接受治療的垂體腺瘤患者病歷資料,滿足由同一組經(jīng)驗豐富的大夫給予經(jīng)鼻蝶竇入路垂體腺瘤切除術(shù)治療、病歷資料完整、有隨訪記錄的患者共101例,其中初治患者81例(80.2%),經(jīng)治患者20例(19.8%)。將經(jīng)治組患者按照是否治愈分成兩組,然后對組間性別、發(fā)病年齡、病程、腫瘤大小、激素水平、侵襲性等臨床因素進行回顧性分析。然后將初治組和經(jīng)治組分別按照是否侵襲生長進行分組,對組間預(yù)后差異進行分析評估手術(shù)再治療的意義。結(jié)果患者性別、發(fā)病年齡、術(shù)前GH/IGF-1水平、腫瘤大小、腫瘤纖維化程度、術(shù)前是否使用善龍均與TSS再次治療的預(yù)后無明顯相關(guān)性,而腫瘤的侵襲性則在治愈與未治愈組間表現(xiàn)出顯著差異。初治組和采用TSS作為再次治療手段的經(jīng)治組間總體治愈率和并發(fā)癥的出現(xiàn)無明顯差異。侵襲性腫瘤患者再次手術(shù)治療出現(xiàn)尿崩并發(fā)癥的機會顯著高于初治患者。結(jié)論TSS再治療可以有效地降低患者的GH水平,雖然治愈率較初次治療有下降趨勢,但是對于改善患者的生存率、生活質(zhì)量、術(shù)后輔助治療的療效都有重要意義。TSS再治療是比較安全的,僅在侵襲性腺瘤中出現(xiàn)尿崩的機會顯著增加,在非侵襲性腺瘤中預(yù)后更好。
[Abstract]:Objective to establish a growth hormone pituitary adenoma database. All the clinical data of the patients were integrated to provide a data basis for scientific research. The patients who met the requirements were selected from the database for analysis. The purpose of this study was to analyze the prognostic factors of the patients who were re-treated with TSS from early 2012 to early 2015. Methods to establish a growth hormone pituitary adenoma database in collaboration with software company, and to record the clinical data of growth hormone type pituitary adenoma patients who had been treated in Peking Union Hospital since 2012. And some of the descriptive indicators that may be used in scientific research are manually identified and input. The medical records of pituitary adenoma patients who were treated in our hospital from early 2012 to early 2014 were consulted from the database. One group of experienced doctors were treated by transsphenoidal approach for pituitary adenoma resection. 101 patients were treated with complete medical records and follow-up records, and 101 patients were treated by transsphenoidal transsphenoidal approach. Among them, 81 cases of newly treated patients and 20 cases of treated patients were divided into two groups according to whether they were cured or not, and then the sex, age, course of disease, tumor size, hormone level of the treated group were analyzed. The invasive clinical factors were analyzed retrospectively. Then the primary treatment group and the meridian treatment group were divided into groups according to the invasion and growth, and the significance of surgical retreatment was evaluated by analyzing the difference of prognosis between the groups. There was no significant correlation between preoperative GH/IGF-1 level, tumor size, degree of tumor fibrosis and the prognosis of TSS retreatment. However, the invasiveness of tumor showed significant difference between cured and uncured groups. There was no significant difference in the overall cure rate and complications between the primary treatment group and the treated group using TSS as the retreatment method, and there was no significant difference in the occurrence of complications in the invasive tumor patients. The chance of complications of urethral avalanche in reoperation was significantly higher than that in the first treatment. Conclusion TSS retreatment can effectively reduce the GH level of the patients. Although the cure rate is decreasing compared with the initial treatment, it is safe to improve the survival rate, the quality of life and the curative effect of postoperative adjuvant therapy. Only in invasive adenomas, the incidence of urinary collapse was significantly increased, and the prognosis was better in noninvasive adenomas.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R736.4
，

本文編號：1526704