莫将垂体瘤当单一肿瘤,须关注内分泌激素对全身影响

2017-06-19 陈明明 澎湃新闻

视力下降、视野缩小、肢端肥大、月经紊乱、不孕不育……这些看似风马牛不相及的病征背后,罪魁祸首可能是同一个——“垂体瘤”。记者从“2017中国神经内镜高峰论坛”上获悉,垂体腺瘤的人群年发病率高达7.5~15/10万人,正常人群随机MRI(核磁共振)检查时垂体腺瘤发现率为10%~38.5%(平均22.5%)。上海交通大学医学院附属瑞金医院神经外科主任医师、博士生导师吴哲褒教授告诉记者:“垂体瘤治疗主要

视力下降、视野缩小、肢端肥大、月经紊乱、不孕不育……这些看似风马牛不相及的病征背后,罪魁祸首可能是同一个——“垂体瘤”。

记者从“2017中国神经内镜高峰论坛”上获悉,垂体腺瘤的人群年发病率高达7.5~15/10万人,正常人群随机MRI(核磁共振)检查时垂体腺瘤发现率为10%~38.5%(平均22.5%)。

上海交通大学医学院附属瑞金医院神经外科主任医师、博士生导师吴哲褒教授告诉记者:“垂体瘤治疗主要包括手术、药物和放射治疗。但是,目前垂体瘤治疗的主要问题就是诊治的不规范和不专业性,导致不少病人被误诊误治。”

脑垂体,也叫垂体,是人体最重要也是最复杂的内分泌腺。脑垂体分泌多种激素,对代谢、生长、发育和生殖等有重要作用。垂体瘤就是发生在垂体上的肿瘤,通常又称为垂体腺瘤。

吴哲褒主任医师告诉记者,尽管绝大多数的垂体腺瘤都是良性肿瘤,垂体腺癌发病率非常低,但是垂体瘤引起的症状会严重损害健康甚至影响寿命,“根据分泌激素的不同,垂体瘤可以分为激素分泌性垂体瘤和无功能腺瘤。”

比如,泌乳素分泌型垂体瘤:多数为女性患者,主要表现为闭经、泌乳、不育。男性患者主要表现为男性性功能低减,如性欲下降、阳痿和不育;

生长激素分泌型垂体瘤:主要表现为巨人症、肢端肥大、面容变丑、血压升高、血糖升高、冠心病等;

促肾上腺皮质激素分泌型垂体瘤:主要表现为向心性肥胖、满月脸、痤疮、多毛等;

促甲状腺激素分泌型垂体瘤:主要表现为高代谢的症状怕热、多汗、体重下降、心慌房颤等;

无功能性垂体肿瘤尽管不影响激素分泌,但随着肿瘤变大会向上压迫视神经,导致视力不清、视野双颞侧偏盲等。

垂体瘤是颅内常见的内分泌肿瘤,其发病率仅次于胶质瘤和脑膜瘤,垂体瘤的综合治疗包括手术、药物、放射治疗及随访观察。比起传统开颅手术,经鼻神经内镜手术由于视野良好、多角度抵近观察使得肿瘤全切率明显提高,且手术创伤小、并发症少、恢复快、住院时间短,已经成为垂体瘤手术的主要方式。

记者从“2017中国神经内镜高峰论坛”上获悉,目前垂体瘤治疗存在不规范和不专业性。吴哲褒主任医师称:“微创内镜技术的临床应用在沿海城市已经普及,但是在内陆地区,医生对于该技术掌握与运用仍有待提高。国内某些地区部分医师观念落后,仍将垂体腺瘤看作单一的肿瘤,而不关注内分泌激素对全身的影响;各地诊治水平不均衡,部分经济欠发达地区尚不能独立开展垂体腺瘤的诊疗工作;还有,垂体腺瘤知识的普及不够。患者的盲目就医,医生的误诊误治,从而严重影响患者的生命和生活质量。”为此,“中国脑垂体基金”应运而生。

吴哲褒主任医师介绍道,“中国脑垂体基金”是目前国内第一只关于垂体瘤治疗和研究的专项基金,旨在宣传正确治疗理念,为基层医生提供专科培训,提升医疗水平;搭建有效就医平台,为垂体瘤患者就医就诊提供导向性便利,并全力扶助贫困患者。该基金挂靠上海市宋庆龄基金会,由基金会对项目进行审核、监督、管理

由于垂体瘤的生长部位、病变大小、病理类型不同,患者年龄、症状、治疗需求也不同,因此针对垂体瘤患者需要实行个体化的规范治疗。吴哲褒主任医师告诉记者:“正确制定垂体瘤的治疗策略,往往比治疗本身更重要。有些偏远地区的病人因为当地医疗水平限制,导致用了错的治疗方案。比如,使用伽玛刀治疗垂体瘤可能会造成视神经损伤,导致患者失明。有时候并非垂体瘤本身有多凶险,而是使用了不正确的治疗手段导致病情迅速恶化。再比如,有些落后地区的医生将垂体瘤当单一肿瘤,只是切除了瘤子,却忽略了内分泌激素对全身影响,垂体瘤治疗不仅仅考虑肿瘤占位压迫周围神经的问题,还要让患者内分泌激素恢复正常。”

“所以‘中国脑垂体基金’不仅仅为在上海交通大学医学院附属瑞金医院诊治的垂体瘤贫困患者,提供免费手术和治疗(妇女儿童优先考虑),还将展开专科培训,资助偏远或内地落后地区的医生到大的垂体瘤中心进修,进行垂体瘤亚专科医师培训,更将组织垂体瘤专家到内地落后地区义诊和授课,普及垂体瘤常识,送医送药。”吴哲褒主任医师表示。

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    2017-07-13 gwc392
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    2017-06-21 chendoc244
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    2017-06-20 luominglian113

    学习,谢谢分享

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    2017-06-19 中医痴

    不错的,学习了,谢谢分享!

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