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Fahr病1例并文献复习

Influence of Bromocriptin on Cardiac Valve in Patients with Pituitary Prolactinoma

ObjectiveTo investigate the risk of cardiac valve regurgitation in patients with pituitary prolactinoma treated with bromocriptine for a long time. MethodsBetween January 2012 and February 2013, 26 pituitary prolactinoma patients treated with bromocriptine for at least 6 months were included in the observation group, and 101 healthy people were regarded as the control group. Transthoracic echocardiography were performed on these patients for cardiac regurgitation, and the echocardiographic data were compared between the two groups. ResultsTrace tricuspid regurgitation was presented in 38.46% of patients in the observation group, and 19.80% of the controls (P=0.046). Interventricular septum thickness was (8.62±0.31) mm in patients in the observation group, and it was (8.57±0.12) mm in the controls (P=0.042). ConclusionNo clinical significant cardiac valve regurgitation has been observed in pituitary prolactinoma patients treated by bromocriptin for a long time. Long-term echocardiographic follow-up of these patients is necessary.

经鼻蝶鞍区病变切除术后鞍底重建及围手术期处理

目的 总结经鼻蝶鞍区病变切除术后鞍底重建及围手术期处理的相关经验。 方法 回顾性分析2007 年10 月－ 2008 年12 月收治的132 例经单鼻孔蝶窦入路行鞍区病变切除术患者鞍底重建及围手术期处理方法。男64 例，女68 例；年龄19 ～ 74 岁，平均45.7 岁。病因：垂体无功能腺瘤91 例，生长激素腺瘤22 例，泌乳素腺瘤9 例，促肾上腺素皮质激素腺瘤2 例，促甲状腺素释放激素腺瘤1 例，Rathke 囊肿5 例，鞍内型颅咽管瘤2 例。术中采用由人工硬膜、颅骨和蝶窦黏膜组成的夹心层法重建鞍底。 结果 术后4 例发生少量脑脊液漏，给予腰大池持续引流1 周后治愈。术后再出血2 例，经药物治疗消退；术后高热、感染3 例，经抗生素治疗后2 例好转，1 例配合腰穿持续引流后治愈。患者均获随访，随访时间28 ～ 42 个月，平均35.2 个月。患者术前症状及体征术后不同程度好转。 结论 以人工硬膜加自体骨片等材料为主体的鞍底重建技术具有解剖还原、操作简便、稳固可靠、创伤小、无排斥等特点，辅以周全的围手术期护理，能够取得良好的重建效果。

Association between Interleukin-1α Polymorphisms and Risk of Intracranial Aaneurysm

目的　探讨白细胞介素1α（IL-1α）基因多态性与颅内动脉瘤发生的关系。 方法　以2010年6月－2012年3月145例颅内动脉瘤患者和181例正常对照者为研究对象，采用聚合酶链反应-限制性片段长度多态性检测IL-1α-889C/T和+4845G/T多态性，统计分析基因多态性与颅内动脉瘤的相关性。 结果　IL-1α-889C/T位点：CT/TT基因型在颅内动脉瘤组中的频率为32.4%，显著高于其在对照组中的频率（21.5%），两组相比差异有统计学意义（χ2=4.90，P＜0.05）；T等位基因在颅内动脉瘤组中的频率为16.9%，显著高于其在对照组中的频率（10.8%），两组相比差异有统计学意义（χ2=5.17，P＜0.05）。IL-1α+4845G/T多态性在两组人群中的分布差异无统计学意义（P＞0.05）。 结论　IL-1α -889C/T多态性与颅内动脉瘤的发病有关，-889T等位基因可能是颅内动脉瘤的遗传易感基因。

Clinical Observation and Quality of Life in Patients with Pituitary Adenoma Treated by Microneurosurgery

【摘要】 目的 分析手术治疗垂体瘤患者长期临床恢复以及生活质量改善情况。 方法 回顾性分析2007年12月-2008年9月手术治疗的103例垂体瘤患者术前以及术后长期随访资料，使用SF-36量表对术前、术后患者生活质量进行评估，分析手术治疗前后患者症状、激素水平恢复情况以及生活质量改善情况，并进一步分析肿瘤大小、侵袭程度对术后生活质量的影响。 结果 术后头痛症状消失52例，视力改善76例，其他症状具有不同程度改善；术后SF-36生活质量评估结果显示，患者除精神健康外的7个维度（生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能）均有明显改善（P＜0.05），不同肿瘤大小及侵袭程度的患者术后生活质量评分均无统计学意义（P＞0.05），垂体功能完全恢复者生活质量评分高于垂体功能低下者（P＜0.05）。 结论 显微手术治疗垂体瘤患者可明显改善患者的一般症状、提高患者的生活质量，单纯肿瘤的大小和侵袭程度对术后生活质量的影响程度较小，术后垂体功能的恢复程度明显影响患者的生活质量，垂体瘤术后患者的激素长期替代治疗尚需进一步加强。【Abstract】 Objective To analyze the long-term clinical recovery and quality of life (QoL) in patients with pituitary adenoma treated by microneurosurgery. Methods The clinical data of 103 patients undergoing microneurosurgery from December 2007 to September 2008 were retrospectively analyzed, health-related questionnairs (SF-36) were used to assess the QoL. The post-surgery recovery of symptoms, endocrine function, and QoL were compared with those of pre-surgery, then the correlation between tumor size, invasive behavior, and QoL were analyzed. Results Headache disappeared in 52 patients. Visual symptoms improved in 76 patients. Other symptoms were also improved. Seven concepts (physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotioning) were improved after surgery (Plt;0.05). The eight health concepts of SF-36 showed no significant difference between patients with different tumor size and invasive behavior (Pgt;0.05). Differences were considered statistically significant between normal and abnormal pituitary function groups after surgery(Plt;0.05) in all concepts. Conclusion Microneurosurgical treatment can improve the general symptoms and the QoL. The tumor size and invasion have little influence on the QoL after surgery, but the improvement of hormone deficiency has influence on the QoL significantly. More attention should be given to the long-term hormone replacement therapy after the pituitary adenoma surgery.

库欣综合征伴足溃疡两例

The application of clinical multi-disciplinary team in the diagnosis and treatment of pituitary adenoma and related diseases

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.