细胞的有丝分裂、增殖,导致血管的狭窄[12]。E2F1在瘢痕内皮细胞中阳性表达,说明它可以促进血管内皮细胞增殖,这也可能是引起瘢痕组织中微血管闭塞或半闭塞的原因之一。综上所述,E2F1的表达和CD105标记的微血管密度在病理性瘢痕明显高于非病理性瘢痕和正常皮肤,他们可能共同参与了病理性瘢痕的发生发展,它们之间存在着相关性,E2F1可能对于病理性瘢痕血管的生成起到重要的作用,这对于E2F1的作用机制研究和病理性瘢痕的抗血管治疗有一定的意义。参考文献[1] H o A.D owdy SF.Regulation of G(1)cell cycle progres si on by oncogenesand tum or suppress or genes.Curr O pin G enet Dev,2002,12(1):47～52.[2] Fonsatt E,Del Vecchil L,Alt ornonte M,et al.Endonglin:An access orycom ponent of the TGF-beta binding receptor-com plex with di agnos ti c, prognos tic,and bi oim munotherapeuteic potential in hum an m ali gnaneies.JC ell phys iol,2001,188(1):1～7.[3] 王营,范培锡,车向明,等.大肠癌中TG Fβ1、转录因子E2F1的表达及临床意义.中国腹部疾病杂志,2001,1(5):368～371.[4] W eidner N,F olkm an J,P oz za F,et al.Tum or angi ogenesis a new signi ficantand i ndependent prognos ti c factor i n early-stage breas t carci n om a.J N atlC ance Inst,1992,84:1875～1887.[5] 陈良友,陆国乎.转录因子E2F与血管再狭窄的研究进展.中西医结合心脑血管病杂志,2005,3(2):153～155.[6] S lanky J E,Fam ham P J.Introduction t o t he E2F fam ily:pr otei n s truct ureand gene regulation.C urr Top Micr obi ol Im munol,1996,208:1～30. [7] 兰斌.核转录因子E2Fs家族研究进展.国外医学消化系疾病分册,2004,24(5):311～314.[8] G ougos A,Letarte M.Identificat i on of a human endothel ial cell antigenwith m on oclonal antibody44G4produced agains t a pre-B leukem ic cell li ne.J I mm uno,1988,141(6):1925～1933.[9] 张健.CD105与恶性肿瘤.淮海医药,2003,21(6):513～514.[10]李小静,盂刚.瘢痕微血管构筑的研究进展.中国临床康复,2002,6(4):480～481.[11]李小静.免疫组化法对不同类型瘢痕微血管的定量研究.实用整形外科杂志,2000,11(4):207～209.[12]C laudi o PP,F ratta L,Farina F,el al.Adeaoviral R B2/p130gmae trans feri nhibit s s m ooth m us cle cell proli ferati on and prevents res tenos i s aft er angio2plasty.C i rc Res,1999,85(11):1032～1039.(收稿日期 2008-09-10)解剖标志及神经内镜下经单鼻孔-蝶窦入路治疗脑垂体瘤吴建珩郑州大学第五附属医院神经外科(郑州 450052) 【摘要】 目的 总结解剖标志及神经内镜下经单鼻孔-蝶窦路径进行垂体瘤切除的手术方法及其疗效。方法 回顾分析42例经蝶内镜切除垂体瘤的手术经验。患者行磁共振成像(MRI)或CT扫描检查,显示鞍区肿瘤并压迫视神经与视交叉。均采用经单鼻孔-蝶窦路径、在神经内镜辅助下摘除。结果 肿瘤全切除38例,近全切除3例,大部分切除1例。手术无死亡病例。本组随访3～36个月,平均10个月。18例视力下降及缺损者中,16例(88.9%)视力迅速恢复,2例(11.1%)好转。视野缺损14例(77.8%)恢复,4例(22.2%)改善。19例术前异常增高的激素水平术后部分逐渐恢复正常,20例术前内分泌功能紊乱者术后症状缓解。结论 解剖定位及神经内镜下经单鼻孔-蝶窦路径切除垂体瘤是一种安全、有效的微侵袭手术方法。【关键词】 垂体肿瘤;神经内镜;解剖标志;经蝶路径;神经外科手术E ndonasal tr anssp henoi da l sur ge ry under a na tomic la ndmar k ne uroe ndoscop e f or pituita ry a de noma W U Jian2 heng.Departmen t o f Neuro surgery,the Fifth Affiliated Ho spital o f Zheng zhou Univ ersity,Zheng zhou450052,Henan 【A bstr act】Objective To rev iew th e surg ical techniqu es and e ffect o f end onasal tran ssph eno idal approach und er anatomic landmark for n euroendos cop ic remo val o f p ituitary ad eno ma.Met hods The ex perien ce with endo scop ic endonasal trans sp hen oidal surgery under anato mic landmark was retro sp ectiv ely reviewed in42cases o f pitu itary aden oma,in which preo perativ e CT or MRI sho wed s ellar masses ca u sing o ptic nerv e a nd o ptic ch iasmal comp res sion s.Results Total remo val was achiev ed in38cases,subtotal in3cases,and partial re2 mo val in1case with tumor.No death o ccurred after surgery.The who le set was followed for a m edian o f10months with a range o f3-36mon th s.Rap id reco v ery o f vi sual acu ity was in88.9%patien ts(16/18)with visual acuity impairm ent and mo derate impro v em ent in 11.1%patien ts(2/18).Among patien ts with preo perativ e vi sual field de fects,p ostop erative reco v ery was achieved in77.8%patients(14/18)and improv ement in22.2%patients(4/18).Abno rmal hormone lev el in19patien ts returned normally and sy mptom s o f endocrinef un ctional disorder in20p atients were also reliev ed after surgery.Conclusion The endonasal ap proach with the neuro endo scope under anato mic landmark may b e a safety and effectiv e min imally in vasiv e method fo r pituitary ad eno ma remov al.【Ke y w ords】Pituitary n eo plasm s;Neuroendo sco pes;Anatom ic land mark;Tra n ssph eno idal approach;Neuro surgical pro cedures 我科于2004年12月至2007年5月,对42例垂体肿瘤采用解剖标志及神经内镜辅助下,经单鼻孔-蝶窦路径的手术切除,手术方法安全、疗效满意。现对此报道如下。 资料与方法 一般资料本组共例,男例,女例,年龄～岁,平均56岁。病程个月～年。1.2 主要临床表现:视力下降及视野缺损18例,其中双眼视力减退15例,单眼3例;视野缺损18例,其中双颞侧偏盲14例,象限性偏盲4例。伴颅内压增高症状2例。合并垂体内分泌障碍症状5例,其中停经、溢乳、性功能低下等内分泌功能紊乱例,头痛例,尿崩例。例激素水平升高,其中泌乳素(RL)腺瘤6例,生长激素(G)腺瘤例,促肾上腺皮7河南外科学杂志2008年11月第14卷第6期HEN AN J OUR NA L OF S UR G ER Y N ov.2008,Vol.14,N o.611.1:4222209 784.1102212221P1H4
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