男性垂体泌乳素混合腺瘤的诊断与治疗

Diagnosis and treatment of male mixed prolactinoma

目的总结男性垂体泌乳素混合腺瘤的诊断与治疗。方法回顾性分析1 84例手术治疗的男性垂体泌乳素腺瘤病人的临床资料。单纯泌乳素腺瘤85例,混合腺瘤99例,其中生长激素-泌乳素混合腺瘤79例(79.8%)。统计分析单纯泌乳素腺瘤和混合腺瘤的临床特征、激素水平、影像学特点和疗效。结果混合腺瘤与单纯泌乳素腺瘤病人的平均年龄、平均病程、临床表现、手术前后泌乳素水平、肿瘤大小均无统计学差异(P>0.05),混合腺瘤蝶窦或鞍旁生长的比例更高(P<0.05),随访完全缓解比例更低(P<0.05)。混合腺瘤与单纯泌乳素腺瘤的全切除、K i-67指数、症状改善、复发情况无统计学差异(P>0.05)。结论垂体泌乳素混合腺瘤的诊断需要结合病人临床表现、内分泌激素检查及术后病理。与单纯泌乳素腺瘤相比,混合腺瘤的发病年龄、肿瘤大小、手术全切比例、术后复发无明显差异。

Objective To summarize the diagnosis and treatment of male mixed prolactinomas. Methods Clinical data of 184 male prolactinoma patients who received surgery were analyzed retrospectively, including pure prolactinomas in 85 patients and mixed prolactinomas in 99. There were 79 patients（79.8%） with growth hormone-prolactinmas. The clinical features, hormone levels, imaging characteristics and therapeutic efficacy of pure and mixed prolactinomas were analyzed statistically. Results There were no significant differences in average age, average disease duration, clinical manifestations, prolactin levels before and after surgery and tumor size between pure and mixed prolactinomas patients（P 〉 0.05）. sphenoid sinus or parasella growth of the tumor was more common and the rate of complete remission was lower in mixed prolactinomas than in pure prolactinomas（ P 〈 0. 05）. There were no significant differences in total removal rate, Ki-67 index, improvement of symptoms and relapse at follow-up between pure and mixed prolactinomas patients（P 〉 0.05）. Conclusions Diagnosis of mixed prolactinomas depends on clinical manifestation, hormone assay and pathological examination. Compared with pure prolactinoma, there exist no significant differences in age, tumor size, total removal rate and relapse rate in mixed prolactinoma.