뇌하수체선종의 수술적 가료 결과

Abstract

The authors report results of surgical management in seventy-four cases of pituitary tumor who were treated in the department of neurosurgery, Keimyung University from Jan. 1987 to Dec. 1992. The composition of cases are prolactinoma in twenty-six cases, growth hormone(GH) secreting tumor in twenty, adrenocorticotropic hormone(ACTH) secreting tumor in three, thyrotropic hormone(TSH) secreting tumor in one and nonsecreting tumor in twenty-four cases. Fourty cases(54.1%) showed suprasellar and/or parasellar extension in the radiological studies. The modalites of management were surgery only in fourty-seven cases and surgery with radiation therapy in twenty-seven cases. Bromocriptin was medicated in twenty-two cases postoperatively. The management results in cases of prolactinoma, thirteen(50.0%) cases were cured and eight(30.8%) cases were improved. In the cases of GH secreting tumor, ten(50%)cases were cured and five(25%) cases were improved Among three cases of ACTH secreting tumor, two cases were cured and there was one case of TSH Secreting tumor which was cured. The worst management result were noticed in the cases of GH secreting tumor which extended suprasellar and/or parasellar region. Of the thirty-five cases who had preoperative visual impairment(twenty-one cases of functional tumor and fourteen cases of nonfunctional tumor), twenty-seven(77.1%) cases were improved, six(l7.19%) cases not improved and two(5.7%) cases aggravated. The common complications after surgical management were hypopituitarism (eleven cases) and transient diabetes insipidus(nine cases). Recurrence was noticed in one case during follow-up period and three cases were expired with one case during perioperative period and two during follow-up period. We conclude that an extensive effort should be made to diagnose early and advance surgical technique so as to improve the results of surgical management of the pituitary tumor.

저자들은 과거 6년간 본원에서 가료하였던 74례의 뇌하수체 선종을 대상으로 술후 호르몬 수치에 의한 치료결과, 시력 혹은 시야장애의 술후 호전율 및 술후 합병증에 대한 조사를 시행한 바 프로락틴 분비선종은 치료율 50%, 호전율 80.8%였고, 성장호르몬 분비선종에서는 치료율 50%, 호전율 75%였다. 부신피질 호르몬 분비선종 3례에서는 Nelson 증후군 1례를 포함하여 2례가 치유되었고, 갑상선호르몬 분비선종 1례도 치유되었다. 수술후 시야 및 시력의 호전율은 77.1%였고 치료후 주요 향병증은 뇌하수체 기능 저하 및 일시적 뇨붕증이었다. 따라서 저자들의 예들에서 치료 성적이 만족스럽지 못한 이유는 맡은 예들이 터어키안 밖으로 신전된 후에야 수술적 가료를 시행한 예들이 많았기 때문으로 생각되고 향후 수술 수기를 향상시키고 종양을 더욱 조기에 발견하여 미세선종의 예들에서 수술적 가료를 시행하는 예들이 증가하면 치료결과도 향상되리라고 생각한다.