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目的评价γ-刀治疗垂体腺瘤的疗效及患者激素水平的变化,以及治疗后的主要并发症。方法对1995年9月-2004年12月经γ-刀治疗并获得完全随访的312例垂体腺瘤患者(包括手术后104例,放射治疗后35例,173例直接采用γ-刀治疗)的临床资料及疗效进行回顾性分析,其中非功能性垂体腺瘤78例,功能性垂体腺瘤234例(催乳素腺瘤124例、生长激素腺瘤37例、促肾上腺皮质激素腺瘤12例、促甲状腺激素腺瘤1例、卵泡刺激素腺瘤8例和混合性腺瘤52例)。根据患者临床症状改善程度、治疗前后肿瘤直径变化及内分泌功能等综合评价疗效。平均随访30.50个月。结果γ-刀治疗后肿瘤完全消失25例(8.01%),缩小152例(48.72%),大小无变化129例(41.35%),增大6例(1.92%),总的肿瘤控制率为98.08%(306/312)。功能性垂体腺瘤患者中77例(32.91%)激素分泌水平恢复正常,102例(43.59%)较治疗前下降,55例(23.50%)无明显改变。γ-刀治疗的晚期并发症主要有视力下降(5例)和垂体功能低下(8例)。结论γ-刀治疗垂体腺瘤患者安全、有效。
Objective To evaluate the efficacy of γ-knife in the treatment of pituitary adenomas and the changes of patients’ hormone levels, as well as the major complications after treatment. Methods The clinical data of 312 patients with pituitary adenoma (including 104 cases after surgery, 35 cases after radiotherapy, 173 cases treated directly with γ-knife) treated with γ-knife and from September 1995 to December 2004 were enrolled in this study. Materials and efficacy were retrospectively analyzed, of which 78 cases of non-functional pituitary adenomas, 234 cases of functional pituitary adenomas (prolactinoma in 124 cases, 37 cases of growth hormone adenoma, adrenocorticotrophic adenoma in 12 cases, and Thyroid hormone adenoma in 1 case, follicle stimulating hormone adenoma in 8 cases and mixed adenoma in 52 cases). According to the degree of improvement of clinical symptoms, tumor diameter changes before and after treatment and endocrine function comprehensive evaluation of efficacy. The average follow-up was 30.50 months. Results Tumor disappeared completely in 25 cases (8.01%) and 152 cases (48.72%) after γ-knife treatment. No change in size was found in 129 cases (41.35%) and 6 cases (1.92%). The total tumor control rate was 98.08 % (306/312). Seventy-three cases (32.91%) of functional pituitary adenomas returned to normal levels of hormone secretion, with 102 cases (43.59%) descending before treatment and 55 cases (23.50%) having no significant changes. γ-knife treatment of advanced complications mainly have decreased visual acuity (5 cases) and hypopituitarism (8 cases). Conclusion γ-knife treatment of pituitary adenoma patients safe and effective.