儿童和青少年垂体瘤的临床诊治分析

Clinical analysis of children and adolescents patients with pituitary adenomas

目的探讨儿童和青少年垂体瘤患者的临床资料和诊治特点。方法回顾性分析1989年至2010年收治的74例儿童和青少年垂体腺瘤患者的病历资料。结果 74例患者中46例(62.2%)发病于青春后期,平均发病年龄17.7岁;男女比例1∶1.85;肿瘤直径0.4～6.0cm;海绵窦侵袭性肿瘤24例(2.4%);泌乳素瘤、无功能腺瘤、促肾上腺皮质激素腺瘤及生长激素腺瘤分别为43例(58.1%)、16例(21.6%)、10例(13.5%)和5例(6.8%)。24例海绵窦侵袭肿瘤患者中,男性14例,女性10例;43例泌乳素瘤患者男性9例,女性34例。74例患者最常见的临床表现为内分泌症状和视力障碍。所有患者均经手术治疗,术前仅9例患者曾接受多巴胺激动剂治疗,术后部分患者行多巴胺受体激动剂治疗和放疗,49例获随访,6例患者复发后再次手术治疗。32例视力障碍患者中有29例术后恢复正常或改善。结论儿童和青少年垂体瘤患者好发于青春后期,各类型肿瘤中男女发病比例不同。在儿童和青少年垂体瘤患者中需普及多巴胺受体激动剂治疗,多巴胺受体激动剂、手术及必要时予以放疗可使患者达到良好的治疗效果。

Objective To describe clinical data and characteristics of diagnosis and treatment in children and adolescents pa- tients with pituitary adenoma. Methods From 1989 to 2010, 74 children and adolescents patients with pituitary adenoma were ana- lyzed retrospectively. Results In the 74 patients, 62. 2% of the tumors occurred in postpubertal age, and the average age of onset was 17.7 years old. The ratio between male and female was 1 ： 1.85. The diameter of tumor was 0. 4-6. 0cm. Twenty-four cases inva- ded cavernous sinus, including 14 males and 10 female. The prolactinomas, nonfunctional adenomas, adrenocorticotropic hormone ad- enomas and growth hormone adenomas were 43 cases（58. 1% ） ,16 cases（21.6% ） ,10 cases（ 13.5% ） and 5 cases（6. 8% ）, respec- tively. There were 14 male and 10 female adenomas were invasive. In the prolactinomas, there were 9 male and 34 female. The most common presenting features were endocrinopathy and visual disturbances. All the patients treated with microsurgery, only 9 patients （12. 2% ） were received dopamine agonists treatment before operation; some patients proceeded postoperative bromocriptine or radio- therapy. Forty-seven cases were followed up, 6 relapsed patients were received surgery again. Twenty-nine patients in 32 recovered or improved from visual disturbances. Conclusion Children and adolescents patients with pituitary adenoma used to appear in postpuber- tal age, the ratio between male and female was different in various types of pituitary adenoma. Dopamine agonists using in treating pro- lactinomas should be further recommended in children and adolescents. The combination of dopamine agonists and surgery, as well as radiotherapy when indicated, can achieve good efficacy in the management of pituitary neoplasm.