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目的探讨术中监测血清GH在预判垂体GH腺瘤全切中的意义。方法对2013年3月-2015年7月通过经蝶手术术中监测血清GH水平治疗28例GH腺瘤的结果进行回顾性分析,术中分别在肿瘤开始切除时0min、切除完毕20min、40min和60min四个时间点监测血浆GH水平,根据3个月后随访结果判定肿瘤是否全切除;将GH<4.5μg/L作为预判肿瘤全切除的指标,并计算各时间点预判肿瘤全切除的敏感性和特应性。结果术中20min时GH<4.5μg/L提示肿瘤全切除的敏感性为5.0%、特异性为29.6%(P<0.05);术中40min时GH<4.5μg/L提示肿瘤全切除的敏感性为15.0%、特异性为32.0%(P<0.05);术中60min时GH<4.5μg/L提示肿瘤全切除的敏感性为90.0%、特异性为75.0%(P>0.05)。结论术毕60minGH<4.5μg/L作为术中GH腺瘤全切除的预判指标是可行的,对预判生长激素腺瘤预后具有重要价值。
Objective To investigate the significance of intraoperative monitoring of serum GH in the prognosis of pituitary GH adenomas. Methods The results of retrospective analysis of 28 cases of GH adenoma treated by transsphenoidal surgery for monitoring serum GH levels from March 2013 to July 2015 were retrospectively analyzed. The results were as follows: 0 min at the beginning of tumor resection, 20 min at the end of resection, 40 min at the end of resection, 60min monitoring of plasma GH levels at four time points, according to follow-up results after 3 months to determine whether the tumor was resected; the GH <4.5μg / L as a preoperative prognostic tumor resection index, and calculate the time point of the total tumor excision Sensitivity and atopy. Results The GH <4.5μg / L at 20min showed the sensitivity of total resection was 5.0% and the specificity was 29.6% (P <0.05). The GH <4.5μg / L at 40min showed the sensitivity of total resection The specificity was 32.0% (P <0.05). The GH <4.5μg / L at 60min showed that the sensitivity and specificity of total resection were 90.0% and 75.0%, respectively (P> 0.05). Conclusions It is feasible to determine the prognostic value of total resection of intraoperative GH adenomas by using 60GGH <4.5μg / L at the end of operation, which is of great value in predicting the prognosis of growth hormone adenomas.