陽子線下垂体照射術に関する臨床的研究—ことにKjellberg式定位的下垂体部分破壊術の先端巨大症に対する適応について

CLINICAL STUDIES ON STEREOTAXIC PROTON BEAM HYPOPHYSECTOMY OF KJELLBERG'S METHOD:Its Indication on Acromegaly

I．序論

　Marie^1）により1886年初めて記載された先端巨大症は，1887年Minkowski^2）により下垂体腺腫に起因するとされ，1901年Frankelら^3）により本症の本態はその機能亢進であることが明らかにされた。

　下垂体腺腫の除去および破壊術は今世紀の初めより行なわれている。Sir Victor Horsley^4）は1889年，経前頭開頭により脳下垂休に到達できたことを報告し，1906年までに10例の手術を施行した。この頃，Schloffer^5）は経鼻的下垂体摘除に成功した。その後，Hirsch^6）の粘膜下鼻中隔到達法，Cushing^7）の口唇下経鼻中隔到達法などの下垂体到達路が考案された。Beclere^8），　Gramegna^9）は1909年，X線照射法を導入し，今日先端巨大症の治療に広く利用されるに至つた。1950年代より種々の放射性物質下垂体挿入による局所的内照射法が開発された^0）〜18）。また高エネルギー重粒子線はX線，γ線に比し特殊な利点を有し，小さなしかも限局性破壊巣の作成が可能であり1954年よりLawrenceらにより導入された^{19）〜22）}。

Kjellberg's method of Bragg-peak proton beam hypophysectomy was described and its favorable effects on acromegaly especially from the endocrinol-ogic points of view were reported.

Twenty-two patients with acromegaly were irradi-ated, 14 of which were followed for 2 to 36 months. In nine, size of hands, feet and 'or face decreased. Clinical findings were also improved to a variable extent, such as headache, fatigability, heat intoler-ance, joint, pain, sexual hypofunction, weight gain, skin changes, tachycardia, hypertension, visual-field defect, disturbed glucose tolerance test, abnormal thyroid function tests, and ketosteroid & hydroxy-steroid scretions. In 12 cases reduction of human growth hormone was noted, although the degree was modest in 4 cases. The follow-up observation showed a gradual decrease in level of human growth hormone, and proved the necessity of longer data for the true judgement of the radiation effects.

This procedure in acromegalic patients has been ac-companied by no mortality, cerebrospinal fluid leak, infection or diabetes insipidus. Complication in this series transient headache, diplopia, and one case of anterior pituitary insufficiency. The first patient with blindness in one eye and focal brain ischemia which developed after the irradiation was treated surgically.

Special attention to the level of human growth hormone was given ; its change by the treatment and its correlation with clinical, endocrinologic, and physical parameters. It was emphasized that the measurement of human growth hormone was essen-tial to a diagnosis of acromegaly and an analysis of the effect of the tretments, either.