下垂体腫瘍の治療成績

RESULTS OF PITUITARY ADENOMA OPERATIONS

Ｉ．はじめに

　下垂体腫瘍の手術方法には，従来種々の方法がとられて来た。最近は，手術顕微鏡の導入により，より広範囲に被膜を含めて切除を試みる傾向にある。虎の門病院悩神経外科では過去13年余にわたつて，60例の症例に，主として現在まで通常に行なわれて来た治療法，即ち腫瘍の被膜下摘除及び術後放射線照射を行なつて来たので，これらの症例について，その治療成績をまとめた。

Between the years 1958 and 1971, 60 patients with pituitary tumors 33 males and 27 females-were?treated at Toranomon Hospital. The number of operations performed was 58. Histologically, 41 cases of all the pituitary tumors were classified as chromophobe adenoma, 8 as eosinophil, 1 as mixed. The conventional subcapsular removal of the tumor with postoperative radiation was used in 53 cases. Only radiation without operation was used in two cases. Three cases were operated microsurgically by the trans-sphenoidal approach.

Neurologically, decrease in visual acuity, defects of visual fields and optic atrophy were chief corn-plaints in many cases. Visual acuity was improved postoperatively in 43%, remained unchanged in 34% and became worse in 23%. Also visual-field defect was improved in 55%, was unchanged in 39% and became worse in 5%. The improvement of visual-field defect was recognized in more cases than that of visual acuity. Optic atrophy was un-changed in most cases postoperatively.

Endocrinologically, amenorrhoe, obesity, acro-megaly and hirsutism were seen in high persentage. Before operation, disturbance of HGH, ACTH, and TSH were detected in 80%, 26% and 16. 7%; after operation, each disturbance was seen in 80%, 30% and 25% respectively. In 15 patients, HGH level was examined pre- and postoperatively. HGH levels were significantly high in 10 acromegalic patients. Of these 10 cases, 6 were operated conventionally, 3 were operated microsurgically by the trans-sphenoidal approach and one was treated by only radiation. In 6 cases operated conventionally, post-operative HGH level decreased not so much or even increased.

In 2 cases operated microsurgically, it became to normal range. In these two cases, HGH level has been within normal range, more than 2 years after operation. As for HGH, therefore, operative effect was not gained by the conventional procedure.

Three cases out of 49 cases followed up died within seven years after operation. 46 cases have survived and 32 cases (about 70%) have been able to return to their works. The remainders, 14 cases (about 30%) have not been able to enjoy their social lives. Because, 7 cases of them have been suffered from severe visual disturbance or blind-ness, and other 7 cases have been suffered from endocrinological disorders,especialy diabetes mellitus and cardiomegaly. Generally, the former was chr-omophobe adenoma and the latter was eosinophilic adenoma.

Finally, it was resulted unexpectedly, that many postoperative patients of pituitary tumor had been suffered from not only visual disturbance but also endocrinological disorder.