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1、中国微侵袭神经外科杂志2017年04月20日第22卷第4期ChinJMinimInvasiveNeurosurg,VOL.22,NO.4,April20,2017·169··临床研究·老年垂体腺瘤的诊治马琳，高路，郭晓鹏，汪强，王子豪，连伟，王任直，幸兵【摘要】目的探讨老年垂体腺瘤的临床和诊治特点。方法回顾性分析110例老年垂体腺瘤病人的临床资料。101例行手术切除治疗，9例未行手术治疗。结果全切除91例，次全切除或部分切除9例，1例为肿瘤凝固性坏死。病理结果均证实为垂体腺瘤。随访78例，时间12～47个月。术前症状均明显好转。术后4个月出现垂体脓肿1例，手术治疗后好
2、转。术后无功能垂体腺瘤进行MRI检查，功能性垂体腺瘤进行激素复查。51例手术病人中，复发3例；5例未行手术病人中，2例行替莫唑胺治疗肿瘤缩小，3例无变化；余22例术后症状改善，未定期行MRI及激素复查。随访期间病人无死亡。结论老年垂体腺瘤起病隐匿，出现视功能障碍时应尽早行垂体MRI检查。在严格评估手术风险后，经鼻蝶入路垂体腺瘤切除是可行的治疗方法。【关键词】垂体肿瘤；老年人；神经外科手术；围术期管理中图分类号：R736.4，R651.13文献标志码：Adoi：10.11850/j.issn.1009-122X.2017.04.007Diagnosisandtreatm
3、entofpituitaryadenomasinelderlypatientsMaLin,GaoLu,GuoXiaopeng,WangQiang,WangZihao,LianWei,WangRenzhi,XingBingDepartmentofNeurosurgery,PekingUnionMedicalCollegeHospital,ChineseAcademyofMedicalSciencesandPekingUnionMedicalCollege,Beijing100730,ChinaAbstract:ObjectiveToexploretheclinical,
4、diagnosisandtreatmentcharacteristicsofpituitaryadenomasinelderlypatients.MethodsClinicaldataof110elderlypatientswithpituitaryadenomaswereanalyzedretrospectively.Thetumorresectionbysurgerywasperformedon101patientsandnosurgeryon9.ResultsThetumorsweretotallyresectedin91patients,subtotallyo
5、rpartiallyresectedin9andcoagulativenecrosiswasseenin1patient.Thepathologicaldiagnosiswasconductedaspituitaryadenoma.Seventy-eightpatientswerefollowedupfor12to47monthsandthesymptomswereimproved.Thepituitaryabsessocurredin1patient4monthsaftersurgeryandimprovedbysurgicaltreatment.Thenon-fu
6、nctioningpituitaryadenomasandfunctioningpituitaryadenomaswereanalyzedbyMRIandhormonereexaminationrespectively.Relapseoccurredin3of51patientsundergoingsurgery.Amongthe5patientswhodidnotreceivesurgery,thetumorshrinkedin2patientswhoreceivedtemozolomideandremainedunchangedin3.Thepostoperati
7、vesymptomswereimprovedintheleft22patientswhodidnotperiodicallyreceiveMRIandhormonereexamination.Therewasnodeathduringthefollow-upperiod.ConclusionsTheonsetofpituitaryadenomaisinsidiousinelderlypatients.ThepituitaryMRIshouldbeperformedforearlydiagnosiswhenvisualdysfunctionsympto
