术前溴隐停治疗对女性泌乳素腺瘤经蝶手术疗效的影响——病例对照研究

The effect of preoperative bromocriptine on the outcome of transsphenoidal microsurgery in female prolactinomas-case control report

目的 研究术前溴隐停治疗对女性泌乳素腺瘤患者经蝶手术疗效的影响。方法 采用病例对照研究方法 ,选择 6 0例术前曾服用溴隐停治疗的女性泌乳素腺瘤经蝶手术患者作为研究对象(术前服药组 ) ,根据临床特点 ,为每名术前服药组患者选择一名术前未服药的女性经蝶手术患者作为对照。两组患者的年龄、病程、治疗前泌乳素水平、肿瘤大小及是否浸润均无统计学差异。结果 术前服药组患者肿瘤质地较韧硬的比例明显高于对照组 ,两组患者肿瘤全切除率基本相同。术前服药组泌乳素由术前 2 71 2 3± 3 2 9ng/ml降至 37 0 1± 7 4 8ng/ml (P <0 0 0 1) ,对照组泌乳素由 2 6 0 0 7±3 15ng/ml降至 34 2 1± 5 90ng/ml (P <0 0 0 1) ,两组患者术后泌乳素值无显著差异 (P =0 6 9)。两组患者手术治愈率亦无明显统计学差异 (术前服药组为 5 1 6 7% ,对照组为 5 8 33% ,P =0 5 )。结论术前溴隐停治疗对女性泌乳素腺瘤经蝶显微外科手术的疗效无明显影响。

Objective Dopamine agonists, represented by bromocriptine, have become the first line treatment for patients with prolactinomas, and have been widely administrated. Since many patients who failed to respond, or could not continue the treatment converted to surgery, there was a corresponding increase in the number of patients who had received preoperative treatment with bromocriptine. But the effect of bromocriptine on surgical outcome of prolactinomas is still a matter of controversy, and this prompted us to review our experience and to design this case control report.Methods 60 female patients with prolactinomas who were preoperatively treated with bromocriptine were chosen as bromocriptine treated group, and a control of the same sex was selected for each case according to pretreatment serum prolactin, tumor size and growth pattern. All the prognostic factors were comparable in the two groups. There were 14 micro and 46 macroprolactiomas in both groups. All the tumors were removed by transsphenoidal microsurgery.Results In the bromocriptine treated group, 19(31 67%) tumors were firm comparing to 6(10%) in control group(P<0 01), but this did not make the operation more difficult. There was no significant difference between the complete removal rate of the two groups. After surgery, serum prolactin decreased from 271 23±3 29ng/ml to 37 01±7 48ng/ml (P<0 001) in bromocriptine treated group, while from 260 07±3 15ng/ml to 34 21±5 90ng/ml(P<0 001) in control group, the difference between post operative prolactin in the two groups was not significant (P=0 69). The surgical cure rate was also comparable in the two groups: in bromocriptine treated group,31(51 67) patients returned to normal prolactin level after surgery, and 35(58 33%) patients in control group (P=0 05). There was no difference between the surgical cure rates of the two groups in patients with either micro or macroprolactinoma. Conclusions Preoperative bromocriptine treatment did not affect the outcome of transsphenoidal microsurgery in female patients with prolactinomas.