Mr. L. came to my office with large hands and feet, a large build, a gruff face, and a low voice, carrying a bag of medical photos. Needless to say, it was another “Mr. Pituitary Tumor” and it was immediately apparent that he was a patient with acromegaly (growth hormone adenoma).
After looking at the film, I found that the tumor was not very large, with a diameter of about two centimeters, but a closer look at the film showed that the right internal carotid artery was partially encircled by the tumor, which was a so-called “blind area for transsphenoidal approach”.
Although pituitary tumor is a benign tumor, a “clean” resection is theoretically a cure, which means you are a normal person after surgery. If the removal is “unclean”, it means that there is residual tumor, and the tumor will grow again after the surgery, so regular review, gamma knife, re-operation or medication will be with you at all times. Not to mention the fear of life and health being threatened at all times, there are endless worries just doing the above things. These are still visible, because there are residual, elevated growth hormone, in addition to the changes in appearance that we can see, the growth hormone also has a huge impact on the “invisible” organs. Patients suffer from a variety of symptoms, including hypogonadism, diabetes, sleep snoring and apnea. Of course, the ideal outcome of surgery is that all of these symptoms disappear after surgery.
As a doctor who has made pituitary tumors his specialty, it is my responsibility to use my skills to help my patients achieve “perfection” as much as possible.
Mr. L’s preoperative growth hormone was 28 ng/l, far from the normal value of less than 2.7 ng/l (Concordia target), and the preoperative outcome was not expected to be optimistic. Several of my assistants and I had a private “bet” that it would be difficult to achieve less than 5 ng/l. Everything went smoothly during the operation, and I knew that the tumor I knew where the “undercover” tumor was hiding, and it was up to you to find out if you had the ability to get him out. The tumor cavity had been largely excised, and my scraping circle gradually moved forward toward the right internal carotid artery, gradually probing deeper and deeper, with the depth, the feel (what Li Shiqi emphasized most), and the biggest problem being safety. The textbook says that the scraping around the pituitary tumor is like “scraping the uterus”, which is a blind scraping, relying on merit, the accumulation of years and years of exploration and operation, the spatial “cracking” of the tumor anatomy in the preoperative reading, and the mind-brain guidance.
I feel that I have been emptied!
On the second day after surgery, the growth hormone result was 3.8 ng/l, and on the seventh day after surgery, it was 1.8 ng/l. The results were unexpectedly satisfactory.
Yesterday, I received a phone call from Tiantan Hospital, saying that I was watching a famous specialist do a transsphenoidal pituitary tumor surgery, and the procedure was “first I couldn’t find the bottom of the saddle, then I found a slit, and later on, under the guidance of another doctor, I did a little bit”. The doctor on the phone exclaimed, “There are specialties in the field.
This also confirms my previous blog post that Titan is not a strong point in doing simple surgeries like pituitary tumors.
I am mortal, I know I can’t do it, but I am determined, I must find – the cell that others have not found.