428例住院垂體瘤患者的臨床資料分析
發(fā)布時間：2018-09-10 13:24
【摘要】：目的:1.分析近3年我院住院垂體瘤患者的臨床發(fā)病特點。2.評估術(shù)前臨床診斷與術(shù)后病理免疫組化染色診斷的一致性。3.提高對垂體瘤的發(fā)病認識并指導治療。方法:1.通過青島大學附屬醫(yī)院HIS系統(tǒng)收集2013年1月-2016年4月于我院神經(jīng)外科、內(nèi)分泌科的住院垂體腺瘤患者,對其病歷資料進行整理、錄入Excel表格:包括姓名、性別、年齡、首發(fā)癥狀、臨床癥狀、影像學表現(xiàn)、手術(shù)方式、垂體激素水平、術(shù)后病理免疫組化染色結(jié)果、并發(fā)癥、術(shù)后用藥等。2.分析患者年齡、性別、首發(fā)癥狀、臨床表現(xiàn)、影像學表現(xiàn)、手術(shù)方式、術(shù)后并發(fā)癥及預后的特征。3.比較患者術(shù)前臨床診斷與術(shù)后病理免疫組化診斷的一致性,運用SPSS21.0統(tǒng)計軟件進行統(tǒng)計分析,P0.05認為有統(tǒng)計學意義。結(jié)果:1.分類:垂體瘤428例,包括PRL瘤54例、GH瘤38例、FSH/LH瘤138例、ACTH瘤11例、TSH瘤1例、多激素腺瘤52例、無功能腺瘤105例、未知功能瘤29例,女性(246例,57.5%)多于男性(182例,42.5%)。2.臨床特征:平均發(fā)病年齡(50.2±12.5)歲,40~60歲多發(fā)(240例,56.1%);垂體瘤壓迫癥狀常見有頭暈頭痛(245例,57.2%)、視力視野改變(285例,66.6%)等,內(nèi)分泌癥狀常見有女性月經(jīng)異常(66例,26.8%)、肢端肥大癥(62例,14.5%)、溢乳(18例,4.2%)、性功能下降(17例,4.0%)等,患者以壓迫癥狀首發(fā)的占75%,以內(nèi)分泌癥狀首發(fā)的占20%,其中女性PRL瘤以閉經(jīng)溢乳首發(fā)多(65.5%)、GH瘤以肢端肥大癥首發(fā)多(65.8%)。3.影像學特點:完善MRI/CT檢查的患者417例(97.4%),大腺瘤占比例高(354例,86.1%),PRL瘤中男性發(fā)生大腺瘤的比例高于女性(t=3.571,P0.05),視力視野改變與視交叉受壓的相符率為66.4%。4.手術(shù)方式與術(shù)后治療:手術(shù)治療407例(95.1%),手術(shù)方式以經(jīng)鼻蝶入路為主(86.0%),大腺瘤手術(shù)并發(fā)癥發(fā)生率高于微腺瘤,術(shù)后使用腎上腺皮質(zhì)激素(75%)、甲狀腺激素(41.6%)替代治療患者多。5.術(shù)前臨床診斷與病理免疫組化染色診斷的一致性:PRL瘤、GH瘤術(shù)前臨床診斷與術(shù)后病理診斷一致性較好(PRL瘤Kappa系數(shù)0.707,GH瘤Kappa系數(shù)0.754);ACTH瘤術(shù)前臨床診斷與術(shù)后病理診斷一致性較差(Kappa系數(shù)0.376),血清ACTH水平升高(ACTH60pg/ml)與術(shù)后病理診斷有較好相關(guān)性(P0.05);男性FSH瘤中FSH升高(FSH15 IU/L)與術(shù)后病理診斷無明顯相關(guān)性(P0.05)。結(jié)論:住院垂體瘤患者中以病理診斷的無功能瘤、FSH/LH瘤最多見;大腺瘤發(fā)病率高;垂體瘤臨床表現(xiàn)多樣化,壓迫癥狀發(fā)生率最高,PRL瘤、GH瘤多以內(nèi)分泌癥狀首發(fā);垂體瘤手術(shù)方式以經(jīng)鼻蝶入路內(nèi)鏡下為主,多數(shù)患者需術(shù)后行激素替代治療;PRL瘤、GH瘤術(shù)前臨床診斷與術(shù)后病理免疫組化染色診斷一致性好,血清PRL、GH、ACTH水平升高對臨床診斷有較大指導意義;垂體瘤診斷需依靠臨床表現(xiàn)、內(nèi)分泌學、影像學檢查及病理免疫組織化學染色檢查的綜合判斷,早期正確診斷對患者選擇最佳治療方案、獲得最佳預后有重要意義。
[Abstract]:Purpose 1. To analyze the clinical characteristics of pituitary adenoma in our hospital in recent 3 years. To evaluate the consistency between preoperative clinical diagnosis and postoperative pathological immunohistochemical diagnosis. 3. 3. To improve the understanding of pituitary adenoma and guide the treatment. Method 1: 1. From January 2013 to April 2016, patients with pituitary adenoma in neurosurgery and endocrine department of our hospital were collected by HIS system of affiliated Hospital of Qingdao University. Their medical records were collected and recorded in Excel form: name, sex, age, etc. Initial symptoms, clinical symptoms, imaging manifestations, operative methods, pituitary hormone levels, postoperative pathological immunohistochemical staining results, complications, postoperative medication, etc. Analysis of age, sex, initial symptoms, clinical manifestations, imaging manifestations, surgical methods, postoperative complications and prognosis. To compare the consistency between preoperative clinical diagnosis and postoperative pathological immunohistochemical diagnosis, SPSS21.0 statistical software was used to carry out statistical analysis (P0.05) that there was statistical significance. The result is 1: 1. Classification: there were 428 cases of pituitary adenoma, including 54 cases of PRL tumor, 38 cases of GH tumor and 38 cases of FSH / LH tumor. There were 1 case of ACTH tumor, 52 cases of polyhormone adenoma, 105 cases of nonfunctional adenoma, 29 cases of unknown function tumor. Women (246 cases, 57.5%) were more than men (42. 5%, 42. 5%). Clinical features: the average age of onset was (50.2 鹵12.5) years old or more than 4060 years old (240 cases, 56.1%), the common symptoms of pituitary adenoma compression were dizziness and headache (245 cases, 57.2%), visual field changes (285 cases, 66.6%), and so on. The common endocrine symptoms were abnormal menstruation (66 cases, 26.8%), acromegaly (62 cases, 14.5%), galactorrhea (18 cases, 4.2%), sexual dysfunction (17 cases, 4.0%), etc. 75 patients were diagnosed with compression symptoms and 20 with endocrine symptoms. Among them, the most of female PRL tumors were amenorrhea galactorrhea (65.5%) and GH tumors with acromegaly (65.8%) .3. Imaging features: 417 cases (97.4%) were improved MRI/CT examination, and the proportion of macroadenoma was high (354 cases, 86.1%). The incidence of macroadenoma in male was higher than that in female (t = 3.571P 0.05). The coincidence rate between visual field change and cross optic compression was 66.4%. Operation and postoperative treatment: 407 cases (95.1%) were treated surgically. Transsphenoidal approach was the main method (86.0%). The incidence of complications in macroadenoma was higher than that in microadenoma. After operation, adrenocortical hormone (75%) and thyroid hormone (41.6%) were used in replacement therapy. The consistency between preoperative clinical diagnosis and pathological immunohistochemical diagnosis of GH tumor is good (Kappa coefficient of PRL tumor is 0.707 and Kappa coefficient of GH tumor is 0.754); preoperative clinical diagnosis of PRL tumor is consistent with postoperative pathological diagnosis. There was no significant correlation between the increase of serum ACTH (ACTH60pg/ml) and postoperative pathological diagnosis (P0.05), and the increase of FSH (FSH15 IU/L) in male FSH tumor was not correlated with postoperative pathological diagnosis (P0.05). Conclusion: in the hospitalized patients with pituitary adenoma, the most nonfunctional FSH / LH tumor was diagnosed by pathology, the incidence of macroadenoma was high, the clinical manifestation of pituitary adenoma was diversified, and the incidence of compression symptom was the highest. Transsphenoidal endoscopy was the main operative method for pituitary adenoma. Most of the patients needed hormone replacement therapy. The preoperative clinical diagnosis of PRL tumor was consistent with the pathological immunohistochemical staining. The clinical diagnosis of pituitary adenoma depends on the comprehensive judgement of clinical manifestation, endocrinology, imaging examination and pathological immunohistochemical staining. Early correct diagnosis is important for patients to choose the best treatment plan and obtain the best prognosis.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R736.4
本文編號：2234570
[Abstract]:Purpose 1. To analyze the clinical characteristics of pituitary adenoma in our hospital in recent 3 years. To evaluate the consistency between preoperative clinical diagnosis and postoperative pathological immunohistochemical diagnosis. 3. 3. To improve the understanding of pituitary adenoma and guide the treatment. Method 1: 1. From January 2013 to April 2016, patients with pituitary adenoma in neurosurgery and endocrine department of our hospital were collected by HIS system of affiliated Hospital of Qingdao University. Their medical records were collected and recorded in Excel form: name, sex, age, etc. Initial symptoms, clinical symptoms, imaging manifestations, operative methods, pituitary hormone levels, postoperative pathological immunohistochemical staining results, complications, postoperative medication, etc. Analysis of age, sex, initial symptoms, clinical manifestations, imaging manifestations, surgical methods, postoperative complications and prognosis. To compare the consistency between preoperative clinical diagnosis and postoperative pathological immunohistochemical diagnosis, SPSS21.0 statistical software was used to carry out statistical analysis (P0.05) that there was statistical significance. The result is 1: 1. Classification: there were 428 cases of pituitary adenoma, including 54 cases of PRL tumor, 38 cases of GH tumor and 38 cases of FSH / LH tumor. There were 1 case of ACTH tumor, 52 cases of polyhormone adenoma, 105 cases of nonfunctional adenoma, 29 cases of unknown function tumor. Women (246 cases, 57.5%) were more than men (42. 5%, 42. 5%). Clinical features: the average age of onset was (50.2 鹵12.5) years old or more than 4060 years old (240 cases, 56.1%), the common symptoms of pituitary adenoma compression were dizziness and headache (245 cases, 57.2%), visual field changes (285 cases, 66.6%), and so on. The common endocrine symptoms were abnormal menstruation (66 cases, 26.8%), acromegaly (62 cases, 14.5%), galactorrhea (18 cases, 4.2%), sexual dysfunction (17 cases, 4.0%), etc. 75 patients were diagnosed with compression symptoms and 20 with endocrine symptoms. Among them, the most of female PRL tumors were amenorrhea galactorrhea (65.5%) and GH tumors with acromegaly (65.8%) .3. Imaging features: 417 cases (97.4%) were improved MRI/CT examination, and the proportion of macroadenoma was high (354 cases, 86.1%). The incidence of macroadenoma in male was higher than that in female (t = 3.571P 0.05). The coincidence rate between visual field change and cross optic compression was 66.4%. Operation and postoperative treatment: 407 cases (95.1%) were treated surgically. Transsphenoidal approach was the main method (86.0%). The incidence of complications in macroadenoma was higher than that in microadenoma. After operation, adrenocortical hormone (75%) and thyroid hormone (41.6%) were used in replacement therapy. The consistency between preoperative clinical diagnosis and pathological immunohistochemical diagnosis of GH tumor is good (Kappa coefficient of PRL tumor is 0.707 and Kappa coefficient of GH tumor is 0.754); preoperative clinical diagnosis of PRL tumor is consistent with postoperative pathological diagnosis. There was no significant correlation between the increase of serum ACTH (ACTH60pg/ml) and postoperative pathological diagnosis (P0.05), and the increase of FSH (FSH15 IU/L) in male FSH tumor was not correlated with postoperative pathological diagnosis (P0.05). Conclusion: in the hospitalized patients with pituitary adenoma, the most nonfunctional FSH / LH tumor was diagnosed by pathology, the incidence of macroadenoma was high, the clinical manifestation of pituitary adenoma was diversified, and the incidence of compression symptom was the highest. Transsphenoidal endoscopy was the main operative method for pituitary adenoma. Most of the patients needed hormone replacement therapy. The preoperative clinical diagnosis of PRL tumor was consistent with the pathological immunohistochemical staining. The clinical diagnosis of pituitary adenoma depends on the comprehensive judgement of clinical manifestation, endocrinology, imaging examination and pathological immunohistochemical staining. Early correct diagnosis is important for patients to choose the best treatment plan and obtain the best prognosis.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R736.4
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