巨大垂体腺瘤的治疗策略

Therapeutic strategy of giant pituitary adenomas

目的通过回顾性分析32例巨大垂体腺瘤病例的临床资料,探讨其治疗策略。方法男性17例,女性15例,平均年龄46.7岁,平均病程4.7年。其中垂体生长激素(GH)腺瘤1例,泌乳素(PRL)腺瘤6例,无功能腺瘤25例。采用经口鼻蝶窦入路手术24例,经额下入路手术1例,经蝶窦和经颅分期手术6例,药物治疗1例。结果手术显微镜下肿瘤全部切除20例,次全切除9例,部分切除2例;手术后放疗10例,药物治疗5例。术后死亡1例。随访6个月～4年,影像学检查显示肿瘤全部切除15例,次全切除14例,部分切除2例;肿瘤无复发。结论对巨大垂体腺瘤,应根据患者的临床表现、内分泌学检查和肿瘤的生长方式决定治疗方案;大多数巨大垂体腺瘤可以首选经蝶窦入路手术,并发症较少,死亡率低;对侵袭性生长的肿瘤,应采用手术、放疗和药物综合治疗。

Objective To retrospectively review clinical data of 32 giant pituitary adenomas and discuss the management of giant pituitary adenomas. Methods Among the 32 patients,17 cases were male and 15 were female. Mean age was 46.7 years old and mean history was 4.7 years. Tumor size was between 4cm to 8cm. Among them,one case was somatotrophic adenoma,6 were prolartionoma,and 25 were non-function adenomas. Twenty-four cases had transsphenoidal surgery,1 had trans-subfrontal craniotomy,6 had both transsphemoidal surgery and craniotomy,1 had only drug therapy. Results Under microscope,20 cases had total removal of tumor,9 had subtotal removal of tumor,and 2 had part removal of tumor. After surgery, 10 cases had radiotherapy, and 5 had drug therapy. Postoperative fellow-up were 6 months to 4 years. MRI showed 15 cases had total removal of tumor, 14 had subtotal removal of tumor,and 2 had part removal of tumor. No one case recurred. Conclusion In giant pituitary adenomas,the operative apporach should be decided according to the clinical manifestation, endocrinological results and growth characters of tumor. Transsphenoidal surgery is the first line therapv in most giant pituitary adenomas. Radiotherapy and drug therapy should be used in some invasive tumors.