| Background and objectivePituitary adenoma is a kind of benign tumor with endocrine function, in the general population, the incidence may be as high as20%[1-2], The incidence rate of pituitary tumor is high, just behind glioma and meningioma in intracranial tumor. Since Griffith and Veerapen [3] reported transnasal approach pituitary adenoma resection technology, this minimally invasive operation mode is gradually used, there is little harassent to the nasal cavity and the the cranial cavity[4], transnasal approach pituitary adenoma resection become a surgical treatment that most pituitary adenomas can choose. But in the end the occur of pituitary adenoma is due to heterogeneous pituitary cell proliferation, the pituitary is an important endocrine organ, pituitary tumor inevitably some clinical symptoms cause by endocrine disorders. While during the transnasal approach pituitary adenoma resection operation, although avoid the harassment to hypothalamus and pituitary in craniotomy operation, more or less inevitably touch the normal pituitary. Touch the normal pituitary may cause hormone disorder after the operation, will also cause the severe hypothalamic reaction, if resection range to the tumor is too large, will also lead to the low pituitary function after surgery. Cause a series of symptoms of low endocrine function. At the present stage there are many researches for the endocrine of pituitary adenoma At home and abroad, but lack of dynamic analysis on postoperative hormone level. The supplement of hormone for the hypopituitarism after operation is not conclusive. Pituitary adenomas according to pathological types can be classified into:Growth hormone (GH)-secretion pituitary tumor; Prolactin (PRL)-secretion pituitary tumor; Adrenocorticotropic hormone (ACTH)-secretion pituitary tumor; Thyrostimulating hormone (TSH)-secretion pituitary tumor; Follicle-stimulating hormone and Luteinizing hormone secreting adenoma; Poly-hormone secreting adenoma; Non-secreting or nonfunctioning pituitary adenoma. For the diagnosis of pituitary adenoma can be divided into clinical and pathological diagnosis. At this stage, mainly on the clinical diagnosis of pituitary adenoma as the principal diagnosis, and postoperative pathological diagnosis and immunohistochemical went unheeded, acceptance of the patients after transsphenoidal resection of pituitary tumors require hormone supplement or not, in what period of time for the supplementary, how to complement and have no precise basis and findings. The purpose of this study is to through the dynamic monitoring and collection, analysis of changes in hormone levels after operation, group respectively according to the clinical diagnosis of pituitary adenoma of pituitary adenoma with immunohistochemical diagnosis, comparison analysis, in order to draw different packet cases postoperative peripheral blood hormone fluctuations in time, to choose the optimal diagnostic mode, optimal time point detection peripheral blood hormone levels to evaluate curative effect after operation, provide time basis for the intervention treatment of hormone, improve the overall effect of surgical treatment of pituitary adenoma patients.MethodSummary147cases who accepted Endonasal transsphenoidal resection of pituitary adenomas pathological diagnosis of pituitary adenoma patients in South hospital neurosurgery department between January2009and June2012. All cases were enhanced MRI, tumors were totally removed, and exclusive postoperative hypopituitarism cases, follow-up of130patients, collect the preoperative patients with clinical diagnosis of130cases,2-4days before the surgery and postoperative peripheral blood hormone level of immunohistochemistry and pathological type of data acquisition. Postoperative follow-up, respectively,3days after the surgery, the time after1months,3months,5months after surgery as a follow-up, patients follow-up analysis of postoperative changes in hormone level. Packet respectively according to the clinical diagnosis of pituitary adenoma of pituitary adenoma with immunohistochemical diagnosis, two groups, contrast changes of serum hormone after the operation of pituitary adenoma, Using statistical software SPSS13.0, measurement information by mean±standard deviation (x±s) that used paired sample t test and Chi-square test count information, P<0.05represents a statistically significant difference.Result1. The concordance PRL adenoid tumor clinical diagnosis and immunohistochemistry is90%, The concordance ACTH adenoid tumor clinical diagnosis and immunohistochemistry is83.85%, The concordance GH adenoid tumor clinical diagnosis and immunohistochemistry is97.7%.2. In130cases of follow-up patients, after clinical diagnosis there are24cases PRL glands tumor, after3days of the operation to after5months of the operation, PRL is gradually declined trend, after3days of the operation, after1months of the operation, after3months of the operation, and after5months of the operation, PRL level respectively and preoperation PRL level make paired comparison, used paired samples t test, results preoperation PRL level, and after3days of the operation, and after1months of the operation, and after3months of the operation, and after5month of the operation, PRL level comparison are no statistics differences (P>0.05).3. According to the clinical diagnostic criteria, the clinical diagnosis of ACTH adenoma and the number of26cases were followed-up, after3days of the operation to5months after the operation, ACTH level showed a downward trend, to the same For the3day after operation, postoperative1month,3months after operation,5months after surgery, ACTH level and a previous time points were compared, using paired samples t test, the results after3day ACTH levels and preoperative ACTH there was a significant difference (P<0.05), and after surgery1months after3days, and after surgery after3months,1months,3months after surgery, the level of ACTH in peripheral blood and the operation after5months compared no significant difference (P>0.05).4. A clinical diagnosis of GH adenoma and followed up7cases, for the3day after operation, postoperative1month,3months after operation,5months after surgery, GH level and a previous time points were compared, using paired samples t test, GH level before and after the3day GH levels had significant difference (P<0.05), and after surgery1months after3days, and after surgery after3months,1months,3months after surgery, the level of GH in peripheral blood and the operation after5months compared no significant difference (P>0,05).5.27cases were diagnosed as PRL in patients with adenomas, preoperative clinical manifestations of18cases of headache, after1months of follow-up in15cases of headache symptoms take improvement than before.5cases, preoperative symptoms in patients with menopause, lactation,1months follow-up symptom disappeared after operation.27cases, preoperative prolactin level was170.39±197.03ng/ml, PRL level in peripheral blood after3days the first review and121.41±176.4ng/ml,3months of peripheral blood PRL level and the operation after5months compared with each other and after surgery1months after3days, and after surgery3months after1months, after the operation, using paired samples t test, the results of preoperative PRL level, after3days,1months after operation3months after surgery, the level of peripheral blood PRL paired has significant difference (P<0.05), but no statistical difference with5months the level of peripheral blood PRL after operation (P>0.05).6.29patients with postoperative pathological diagnosis was ACTH adenoma, ACTH at1months,3months,5months, the average values decreased to normal level, Take the same paired sample t test for3months, the level of ACTH in peripheral blood in3days after surgery and preoperative, postoperative and the operation after1months,3days after operation and the operation after3months,1months after operation and the operation after5months compared with each other. Results the3 day after operation and before surgery, and in1months after the3, the level of ACTH in peripheral blood were compared with statistical difference (P<0.05), and after operation and the operation after3months and1months,3months after surgery, the level of ACTH in peripheral blood and the operation after5months without statistics differences (P>0.05).7.8cases of GH adenoma were followed up, preoperative mean GH level of32.36±27.45U/L,3day after operation, the level of GH in peripheral blood decreased gradually, Take the paired sample t test was used for the3day after operation and before surgery, and the operation after1months3days, and after surgery after3months,1months,3months after surgery, the level of GH in peripheral blood and the operation after5months compared with each other, the3day after operation and operation before and after the operation, and the operation after1months3days, and after surgery3months and1months after the peripheral blood levels of GH paired were compared with statistical difference (P<0.05). But after operation compared to3months GH level and the operation after5months was not statistically significant (P>0.05).8.130cases, preoperative TSH average of1.58±1.21mlU/L (TSH:0.55-4.78mlU/L normal value), the3day after operation, the level of TSH decreases, gradually recovered1months after operation. Preoperative FT3average of2.71±0.64pg/ml (FT3:2.3-4.2pg/ml normal value), after3days of decline trend, gradually recovered1months after operation. Preoperative FT4average of1.12±0.27pg/ml (0.89-1.76ng/dl normal value), after3to5months after operation, maintenance of fluctuations in the normal range.Conclusion1. Postoperative pathological diagnosis was PRL adenoma patients, can be take the supplementary treatment of the corresponding hormone in after3days to5months postoperative based on pathological diagnosis. Postoperative pathological diagnosis of ACTH adenoma patients, according to the results of pathological diagnosis of patients, it can take hormone replacement therapy after3months of the operation.2. The clinical diagnosis of GH adenoma after3days can be hormone replacement therapy based on clinical diagnosis, the therapy can not by clinical diagnosis within3to7months, according to the pathological diagnosis of GH adenoma patients, it can be hormone replacement therapy based on clinical diagnosis after5months of hormone replacement therapy.3. TSH, FT3, FT4there is a certain degree of volatility, there were decreased after operation,1months after the operation they are gradually recovered to a stable level,1months after operation need not supplementary treatment.Innovations of our study:Through the130cases underwent transsphenoidal pituitary adenoma resection, and postoperative pathology confirmed the diagnosis of pituitary adenoma patients, take the clinical diagnosis and pathological diagnosis classification, dynamic follow-up analysis of hormone levels these two kinds of diagnostic methods before and after operation, different diagnosis methods, changes of hormone levels after operation time, formulate postoperative review to assess the operation efficiency, as well as to provide theoretical basis for postoperative hormone therapy, the patients take clinical diagnosis preoperative and treatment pathological diagnosis postoperative, according to supplement hormones and related to disease treatment results, improve the overall effect of surgical treatment of pituitary adenoma patients. |
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