手术治疗男性垂体泌乳素腺瘤73例临床分析

Clinical analysis of 73 male patients with pituitary prolactinoma treated by surgery

目的分析男性垂体泌乳素腺瘤的临床特点,探讨其综合治疗方法。方法回顾性分析73例经手术治疗男性泌乳素腺瘤病人的临床资料。根据血清泌乳素水平,分为泌乳素≥200 ng/ml组(n=59)及泌乳素<200 ng/ml组(n=14),分析两组的临床和病理特点。结果泌乳素≥200 ng/ml组病人的性功能障碍发生率明显高于泌乳素<200 ng/ml组(P<0.05)。泌乳素与肿瘤平均直径具有相关性(r=0.747,P<0.01)。肿瘤全切37例,大部切除36例。术后病理证实均为垂体泌乳素腺瘤,其中55例为侵袭性腺瘤。术后性功能恢复正常者29例,视力、视野改善者31例。术后辅助药物治疗58例。随访65例,时间36个月,复发11例。结论男性泌乳素腺瘤多呈侵袭性生长,肿瘤大小与泌乳素水平呈正相关。对于压迫症状较重、肿瘤囊变、肿瘤卒中的男性病人,手术联合药物综合治疗是合理选择。

Objective To analyze the clinical characteristics of male patients with pituitary prolactinoma and explore the comprehensive therapy. Methods Clinical data of 73 male patients with prolactinoma who underwent microsurgery were analyzed retrospectively. According to serum prolactin level, the patients were divided into prolactin≥ 200 ng/ml group （n = 59） and prolactin 〈 200 ng/ml group （n = 14）. The clinical and pathological characteristics were analyzed in patients between the two groups. Results The rate of sexual dysfunction was significantly higher in patients with prolactin ≥200 ng/ml than that in patients with prolactin 〈 200 ng/ml （P 〈 0.05）. The prolactin level was correlated with mean diameter of tumor （r = 0,747, P 〈 0.01）. Complete tumor resection was achieved in 37 patients and subtotal resection in 36. All the patients were diagnosed as having prolactinoma by postoperative pathological analysis including 55 patients with invasive adenoma. The sexual function recovered in 29 patients, and eyesight and visual field were improved in 31 after surgery. And 58 patients were treated with adjuvant medication after surgery. Sixty-five patients were followed up for 36 months, and tumors recurred in 11 patients. Conclusions Prolactinoma in male is usually invasive. The tumor size and prolactin level are positively correlated. For the male patients with severe oppressive symptom, tumor cysts and stroke, the comprehensive therapy of surgery combined with medication is a proper choice.