溴隐亭治疗侵袭性巨大泌乳素腺瘤的长期随访结果

Treatment of invasive giant prolactinomas with bromocriptine: results of long-term follow-up

目的 观察溴隐亭治疗侵袭性巨大泌乳素腺瘤的长期随访结果。方法 纳入侵袭性巨大泌乳素腺瘤 (IGPs)的标准是:⑴肿瘤直径 4cm以上,侵袭海绵窦或邻近其他结构;⑵血浆PRL>200ng/ml;⑶高泌乳素分泌或占位效应引起的临床症状。符合标准者 20例,其中 6例为术后给以溴隐亭治疗,其余 14例首发溴隐亭治疗。11例配合放疗。结果 所有患者临床症状均得到不同程度改善。在平均随访的 37 3个月内肿瘤体积平均缩小 93 3%, 11例肿瘤在MRI上消失。视力下降者除 1例外其余均获得改善(13 /14)。PRL水平控制正常者 8例,大于 200ng/ml者 7例。服药过程中出现脑脊液漏 1例,行经蝶修补。本组在治疗过程中无肿瘤卒中及耐药现象发生。结论 溴隐亭为侵袭性巨大泌乳素腺瘤的首选治疗,能在较短的时间内有效缩小肿瘤体积和控制PRL水平。部分患者服药后肿瘤消失,另一部分患者肿瘤局限后给以立体定向放射外科治疗,从而避免手术风险和手术费用。溴隐亭对控制PRL和缩小肿瘤体积不是同等敏感的。放疗的选择宜慎重。

Objective To observe the long term follow up outcomes of treating invasive giant prolactinomas (IGPs) with bromocriptine. Methods The criteria of IGPs includes: ⑴ diameter is more than 4 cm, invading the cavernous sinus or other adjacent structures; ⑵ serum prolactin level > 200 ng/ml; ⑶ clinical signs of hyperprolactinemia/mass effect. 20 patients met the criteria. Six cases had undergone microsurgery before bromocriptine treatment. The other 14 patients were given medical treatment initially. 11 patients accepted adjuvant radiotherapy. Results All clinical symptoms had improved in different degrees. Tumor volume on MRI was decreased on average by 93 3% through the average 37 3 month follow up. Tumor disappeared on MRI in 11 patients. Visual symptoms had improved in thirteen patients except one. There were 8 patients whose prolactin level was normal whereas 7 patients' prolactin level more than 200ng/ml. CSF leakage occurred in one case, who underwent transsphenoidal surgery to repair it. There was no apoplexy and resistance to bromocriptine during medical treatment. Conclusions Bromocriptine is very effective as a first line therapy for invasive giant prolactinomas, which can significantly shrink tumor volume and control prolactin level. Tumors disappear in a part of patients and the other patients whose tumor localized can undergo stereotactic radiotherapy, which can avoid the risk of surgery with less expenditure. Bromocriptine is not parallelly sensitive to shrink tumor volume and to control prolactin level. It should be carefully considered about radiotherapy.