肢端肥大症之治療趨勢與護理

肢端肥大症是生長激素與類胰島素生長因子過度分泌所引發，病程複雜緩慢，須八至十年才可確診，主要危險因子為腦下垂體增生腺瘤、中樞或周邊腫瘤及遺傳性疾病，若不及時治療，死亡率是一般人的2－4倍。此病臨床表徵為身體外觀改變，全身性病理性病變，如心血管、新陳代謝、呼吸道、消化道及骨關節等系統性病變。經蝶竇腦下垂體腫瘤切除手術是首選治療方式，但對無法完全切除的腫瘤或無法手術者，需輔以藥物及放射治療。然而，部分研究指出，肢端肥大症之治療藥物可能引發血糖不穩、腸胃不適，而放射線治療則需視腫瘤大小及位置而決定；以傳統放射治療控制病情常需耗時多年，而立體定位放射治療可精確定位病灶，療程短，迅速改善病情，但視交叉須避免過多的放射線照射。護理重點為妥善提供腦下垂體腫瘤切除手術前、後之照護，熟悉藥物作用及副作用，密切觀察併發症，緩解醫療處置帶給患者之副作用。由於台灣仍欠缺相關研究及文獻，期望本文有助醫護人員之臨床照護。

關鍵字

肢端肥大症；治療趨勢；腦下垂體腫瘤；護理

並列摘要

Acromegaly is a complex and slow progressive disease which is caused by an elevated level of growth hormone and insulin-like growth factor-1. It may need to take 8 to 10 years to confirm the diagnosis. The major risk factors of acromegaly are pituitary tumor, central or peripheral tumors, and genetic diseases. Acromegaly carries a high mortality rate if it is not adequately treated. The clinical symptoms of acromegaly include changes in body appearance and systemic pathological changes, such as cardiovascular disease, glucose intolerance, respiratory and digestive diseases, and arthropathy. Transsphenoidal adenectomy is the priority therapeutic option for resection of pituitary tumor. Yet for patients who cannot have the tumor be completely removed or are intolerable to surgery, alternative treatments such as medication or radiation therapy are suggested. Nevertheless, some studies have shown that some medication for acromegaly may easily induce glucose intolerance or gastrointestinal upset. Moreover, the effectiveness of radiation therapy depends on the size and location of the tumor. Traditional radiation therapy often takes years to control this disease. Although stereotactic radiotherapy can accurately locate the lesion, has a short course for treatment, and can quickly improve the condition, still excessive radiation exposure to the chiasm should be avoided. Nursing care should focus on the pre- and post-surgery care of resection of pituitary tumor. Nurses are suggested to be familiar with the effect and side effects of medications, observation of complications, and how to relief the physical and psychological issues caused by the treatment procedures. Since the relevant literature in Taiwan is still lacking, we hope this article can help clinicians and nurses provide a better quality of management.

並列關鍵字

acromegaly ； treatment trend ； pituitary tumor ； nursing care

參考文獻

王愷君、翁錦興（2017）．肢端肥大症．臨床醫學月刊，80（3），511-522. doi:10.6666/ClinMed.2017.80.3.096

陳涵栩（2017）．肢端肥大症的診斷及治療．臨床醫學月刊，79（5），292-299. doi:10.6666/ClinMed.2017.79.5.054

張天鈞（2016）．肢端肥大症之診治：台灣專家共識．內科學誌，27（6），283-294. doi:10.6314/JIMT.2016.27（6）.01

Adelman, D. T., Liebert, K. J., Nachtigall, L. B., Lamerson, M., & Bakker, B. (2013). Acromegaly: the disease, its impact on patients, and managing the burden of long-term treat-ment. International Journal of General Medicine, 6, 31-38. doi:10.2147/IJGM.S38594

Hannah-Shmouni, F., Trivellin, G., & Stratakis, C. A. (2016). Genetics of gigantism and acromegaly. Growth Hor-mone & IGF Research, 30-31, 37-41. doi:10.1016/j.ghir.2016.08.002

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肢端肥大症之治療趨勢與護理

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