中国实用外科杂志

中国实用外科杂志

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减重与代谢手术病人垂体磁共振检查临床适用性评价

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  1. 1首都医科大学附属北京友谊医院 a.放射科 b.普通外科中心减重与代谢外科，北京 100050；2国家消化系统疾病临床医学研究中心，北京 100050
  • 出版日期:2020-04-01 发布日期:2020-04-17

  • Online:2020-04-01 Published:2020-04-17

摘要： 目的    探讨垂体磁共振（MR）检查在减重与代谢手术病人中常规开展的必要性及其应用条件。方法    回顾性分析2016年1月1日至2019年12月31日首都医科大学附属北京友谊医院普通外科中心减重与代谢外科收治的行垂体MR检查的312例代谢综合征病人的临床资料。将MR检查结果根据影响临床决策的程度分为Ⅰ~Ⅴ类。统计垂体MR检查的整体阳性率、检查目的相关阳性率、影响临床决策阳性率。结果    垂体MR检查结果中Ⅰ类263例（84.3%），Ⅱ类15例（4.8%），Ⅲ类21例（6.7%），Ⅳ类3例（1.0%），Ⅴ类10例（3.2%）。整体阳性率为15.7%（49/312）；检查目的相关阳性率为7.7%（24/312）；影响临床决策阳性率为0.6%（2/312），包括垂体大腺瘤1例、脑肿瘤1例。 结论    对于减重与代谢手术病人，因垂体MR平扫检查阳性率低，为临床提供价值较小，极少影响临床决策，不推荐常规开展；对于临床怀疑垂体病变所致继发性肥胖或病人，推荐垂体MR增强检查；对于伴中枢神经系统症状病人，推荐颅脑MR增强检查。

关键词: 垂体, 磁共振, 减重手术, 代谢综合征, 临床适用性

Abstract: The clinical appropriateness assessment of pituitary magnetic resonance examination in patients with bariatric surgery        LV Han*，LIU Yang，SUN Jing，et al. *Department of Radiology，Beijing Friendship Hospital，Capital Medical University，Beijing 100050，China
Corresponding authors：ZHANG Zhong-tao，E-mail：zhangzht@ccmu.edu.cn；WANG Zhen-chang，E-mail：cjr.wzhch@
vip.163.com
LV Han and LIU Yang are the first authors who contributed equally to the article
Abstract    Objective    To analyze the necessity and conditions of the pituitary MR examination in patients with bariatric surgery，providing object evidence for appropriateness assessment. Methods    Based on the medical database of our clinical center，we retrospectively analyzed 312 patients with metabolic syndrome who visited Department of General Surgery，Metabolic and Bariatric Surgery，Beijing Friendship Hospital，Capital Medical University from Jan.1，2016 to Dec.12，2019 and performed pituitary MR examination. The result of MR will be divided into Ⅰ~Ⅴ. The rates of overall positive findings，positive findings that are associated with the purpose of examination，positive findings that may affect clinical decisions (cases needed other treatments) were reported. Results    There were 273 (84.3%) patients in group Ⅰ，15 (4.8%) patients in group Ⅱ，21 (6.7%) patients in group Ⅲ，3 (1.0%)patients in group Ⅳ and 10 (3.2%) patients in group Ⅴ.The rates of overall positive findings was 15.7%，rates of positive findings that are associated with the purpose of examination was 7.7%，positive findings that may affect clinical decisions was 0.6%，including one case of pituitary giant tumor and one case of brain tumor. Conclusion    Pituitary MR examination without contrast provides limited information and for clinic in patients with bariatric surgery due to low positive rate. It is less likely to affect clinical decisions. Thus，it is not recommended as a routine examination. For patients with secondary that is suspicious of pituitary abnormalities，MR scan with dynamic contrast enhancement is recommended. For patients with neurological symptoms，brain MR scanning is recommended.

Key words: pituitary, magnetic resonance(MR), bariatric surgery, metabolic syndrome, clinical appropriateness