ObjectiveTo explore the effectiveness of the usage of artificial bone of tricalcium phophate in sellar floor reconstruction after transsphenoidal microsurgery for pituitary adeoma. MethodsBetween January and December 2014, 85 patients with pituitary adema underwent transsphenoidal microsurgery, and the clinical data were retrospectively analyzed. "Sandiwich" was used for sellar floor reconstruction in 46 cases (control group), and "sandiwich" combined with the artificial bone of tricalcium phophate in 39 cases (trial group). There was no significant difference in gender, age, disease duration, size of tumor, invasiveness, and the degree of damage to the sellar floor between 2 groups (P>0.05). ResultsTotal removal and subtotal removal of tumors were achieved in 39 cases and 7 cases of the control group, and in 33 cases and 6 cases of the trial group, showing no significant difference between 2 groups (Z=-1.303, P=0.193). Cerebrospinal leakage occurred in 8 cases of the control group and in 10 cases of the trial group during operation, showing no significant difference (Z=-1.748, P=0.080). The case number of cerebrospinal leakage in the control group (4 cases) was significantly more than that in the trial group (0) after operation (P=0.020). The time of gauze removal in the trial group (3 days) was significant shorter than that in the control group[(4.3±1.6) days] (t=2.236, P=0.033). The patients were followed up 3-14 months in the control group and 5-13 months in the trial group. No cerebrospinal leakage occurred during follow-up. ConclusionSellar floor reconstruction with artificial bone of tricalcium phophate is safe, and it can reduce cerebrospinal leakage and shorten the time of gauze removal.
目的:对照研究Fascin在侵袭性和非侵袭性垂体瘤中的表达差异,探讨Fascin的表达与垂体瘤侵袭性的关系。方法:应用Envision二步免疫组化方法,通过测定各样本平均光密度值和积分光密度值,比较侵袭性和非侵袭性垂体腺瘤、不同病理类型、不同体积肿瘤中Fascin的表达差异。结果:Fascin在侵袭性垂体腺瘤的表达明显高于非侵袭性垂体腺瘤,其表达水平与垂体腺瘤的侵袭性正相关,巨大型肿瘤的表达明显高于小型肿瘤,不同病理类型之间无显著差异。结论:Fascin的表达与垂体腺瘤的侵袭生长有关,与垂体瘤大小有关,与病理类型无关。
Multi-disciplinary team (MDT) is increasingly applied in oncology and refractory diseases. In recent years, MDT has also been applied in diagnosis and treatment of pituitary adenoma and related diseases. This review summarizes the advantages and characteristics of the MDT diagnosis and treatment mode, and analyzes the application and effect of the MDT diagnosis and treatment mode in the Center of Pituitary Adenoma and Related Diseases, West China Hospital, Sichuan University. So far, it has shown that MDT has advantages such as it is professional, full of collaborative interaction, and efficient and optimized. It is a platform of multi-disciplinary cooperation and resources in the diagnosis and treatment of difficult diseases. Case discussion in MDT mode is conducive to timely selection of the best treatment options for patients with pituitary adenoma and related diseases, providing a good learning platform for doctors with different professional backgrounds, and promoting the improvement of professional diagnosis and treatment level of doctors in related departments. The development of MDT will help us to use limited medical resources efficiently, promote the medical team to be more specialized, optimize the diagnosis and treatment process, and improve the effectiveness of the treatment, for benefiting more patients with pituitary adenomas and related diseases.
【摘要】 患者为老年男性,反复出现恶心、呕吐、乏力、低钠、低钾血症, 3次住院。对其恶心呕吐原因,曾考虑是否有抗高血压药物吲哒帕胺所引起,或是老年人摄入不足,电解质紊乱所致低钠低钾血症。最后考虑该患者低钠血症系垂体前叶功能减退所致。MRI检查显示空蝶鞍。空鞍的原因尚不清楚,空鞍综合征也是垂体前叶功能减退的因素之一。此症尽管很少见,但随着CT、MRI这些高新设备的普遍使用及人口老龄化,会发现更多的病例,也对我们诊断治疗提供了有力的依据。【Abstract】The patient’s condition: old male patient with repeat nausea, vomitus, hypodynamia, low sodium and kaliopenia. Three times to be in hospital. First, we consider that indapamide resuted low sodium and Kaliopemia,but we discovered that the anterior pituitay gland hypofunction. MRI show that empty sella turcica. The reason of empty is not clear,the saddle syndrome is also a factor of pituitary function before the leaves falling off. The disease was rare,but with common use of CT,MRI and aging,we will discover many more cases to provide power evidence for diagnosis and treatment.
目的:研究空蝶鞍综合征(ESS)患者的X线、CT、MRI表现,探讨三种诊断方法在ESS的诊断价值。材料与方法:32例ESS具有完整的X线、CT、MRI及临床资料。结果:X线、CT、MRI均能发现蝶鞍扩大,X线不能分辨鞍内结构;CT可显示垂体萎缩,识别75％的垂体柄,有少量伪影干扰,观察细节受影响;MRI完全显示鞍区解剖结构及信号变化。结果:MRI是ESS的最佳影像学诊断手段。
摘要:目的:探讨神经内镜经单鼻腔蝶窦入路在切除垂体腺瘤中的临床应用。 方法:对58例垂体腺瘤患者进行手术切除。应用神经内镜直接自单鼻腔进入,暴露双侧蝶窦开口,打开蝶窦前壁进入蝶窦腔切除肿瘤。 结果: 肿瘤全部切除42例,约占 72%;次全切除16例,约占28%,无严重并发症。结论:神经内镜经单鼻腔蝶窦入路切除垂体腺瘤是一种更微创、暴露更好、并发症少的手术方式。Abstract: Objective: To investigate the clinic application of endoscopic end nasal transsphenoidal surgery for pituitary tumors. Methods: 58 patients were treated. A endoscope was used to open the anterior wall of the sphenoid sinus and resected tumors. Results: 42 cases (72%) underwent total resection, 16 cases (28%) underwent subtotal resection. No severe complications was found. Conclusion: Endoscopic end nasal transsphenoidal surgery for pituitary tumors can reduce the tissue trauma, improved visualization, more complete tumor removal, and reduce complications.
【摘要】 目的 探讨减少输卵管间质部妊娠腹腔镜术中失血的方法。 方法 选择2007年1月-2010年6月49例诊断为输卵管间质部妊娠的患者随机分成观察组（24例）和对照组（25例）。观察组在腹腔镜切开异位妊娠病灶前于宫角注射垂体后叶素6 U，待子宫收缩后手术；对照组直接切开异位妊娠病灶进行手术。比较两组手术时间、术中出血量、血压、术后肛门排气时间、体温等方面的差异以及随访患者月经恢复时间。 结果 观察组和对照组手术时间分别为（34.29±7.96）、（53.68±10.48） min，术中出血量为（48.04±9.49）、（85.52±15.24） mL，差异有统计学意义（Plt;0.05）；两组在术后肛门排气时间、术后体温、术前血压、妊娠病灶切开后5 min的血压以及观察组使用垂体后叶素前后的血压差异均无统计学意义（Pgt;0.05）。两组患者在术后30～41 d月经复潮。 结论 输卵管间质部妊娠腹腔镜术中使用垂体后叶素能明显缩短手术时间和减少术中出血量，不增加持续性宫外孕的发生。【Abstract】 Objective To explore the method of reducing bleeding in laparoscopy for interstitial pregnancy. Methods Forty-nine patients diagnosed to have interstitial pregnancy between January 2007 and June 2010 were randomly divided into observation group (24 cases) and control group (25 cases). Patients in the observation group were given an injection of 6 U pituitrin in the horn of uterus before the incision of lesions in laparoscopy, and operation was performed after uterine contraction; while the lesions of patients in the control group were directly incised. The differences between the two groups in operation time, blood loss during the operation, blood pressure, exhaust time and temperature were studied and the recovery time of menstrual period was followed up. Results The operation time of the observation group and the control group was (34.29±7.96) minutes and (53.68±10.48) minutes; the blood loss was (48.04±9.49) mL and (85.52±15.24) mL, respectively. The difference in the operation time and blood loss between the two groups was significant (Plt;0.05). The difference in other indexes between the two groups such as the exhaust time, postoperative body temperature, the blood pressure before operation and within five minutes after the incision of the lesion was not statistical (Pgt;0.05). The recovery time of menstrual period in the two groups was 30 to 41 days. Conclusion Using pituitrin in laparoscopy for interstitial pregnancy can significantly shorten operation time and reduce blood loss, and will not increase the incidence rate of persistent ectopic pregnancy.