内镜手术治疗泌乳素腺瘤的疗效分析

Efficacy of Endoscopic Surgery in the Treatment of Patients with Prolactin Secreting Adenoma

目的:探讨不同类型泌乳素腺瘤在内镜手术治疗中的差异,为临床方案的选择提供指导。方法:回顾性分析2015年1月—2016年10月甘肃省人民医院神经外科经内镜下经鼻蝶垂体瘤手术治疗的28例垂体泌乳素腺瘤病例。依据肿瘤体积、侵袭程度、手术前血清泌乳素水平及影像学分类,依据术后泌乳素水平评估手术疗效。结果:泌乳素微腺瘤8例,全切者8例,全切除率100.00%。泌乳素大腺瘤16例,全切者9例,全切除率为56.25%。泌乳素巨大腺瘤4例,全切者1例,全切除率为25.00%。泌乳素微腺瘤全切除率优于泌乳素大腺瘤及泌乳素巨大腺瘤,差异有统计学意义(P<0.05)。非侵袭性泌乳素腺瘤的全切除率优于侵袭性泌乳素腺瘤,差异有统计学意义(P<0.05)。血清泌乳素水平≤100ng/ml组与≥200ng/ml组的手术后降低率相比较,差异有统计学意义(P<0.05)。泌乳素微腺瘤的手术治疗有效率优于泌乳素大腺瘤及泌乳素巨大腺瘤,差异有统计学意义(P<0.05)。非侵袭性泌乳素腺瘤的手术后泌乳素降低率优于侵袭性泌乳素腺瘤,差异有统计学意义(P<0.05)。结论:内镜手术治疗泌乳素腺瘤疗效确切,患者手术后的血清泌乳素下降程度与肿瘤大小、生长方式及术前泌乳素水平有关。泌乳素微腺瘤和非侵袭性泌乳素腺瘤的全切除率高,手术效果较好。

Objective：To investigate the differences between different types of prolactinoma in endoscopic surgery and to provide guidance for the selection of clinical regimens.Methods：Retrospective analysis of 28 cases of pituitary prolactinoma treated by endoscopic transsphenoidal pituitary tumor surgery from January 2015 to October 2016 in Gansu Province People＇s Hospital,including 3 males and 25 females.According to tumor volume,degree of invasion,preoperative serum prolactin levels and imaging classification,according to postoperative prolactin levels to assess the efficacy of surgery.Results：8 cases of prolactin microadenoma,total resection in 8cases,the total resection rate of 100.00%.Prolactin large adenoma in 16 cases,total resection in 9cases,the total resection rate of 56.25%.Prolactin giant adenoma in 4 cases,total cut in 1 case,the total resection rate of 25.00%.The total resection rate of prolactin microadenoma was superior to prolactin adenoma and prolactin giant adenoma,which was statistically significant（P〈0.05）.The total resection rate of noninvasive prolactin adenoma was superior to that of invasive prolactin adenoma（P〈0.05）.Serum prolactin levels≤100ng/ml group were significantly different from those in the≥200ng/ml group（P〈0.05）.The effective rate of microprotectin adenoma was superior to prolactin adenoma and prolactin giant adenoma,which was statistically significant（P〈0.05）.The rate of prolactin reduction after surgery was superior to that of invasive prolactin adenoma（P〈0.05）.Conclusion：Endoscopic surgery is effective in the treatment of prolactinoma.The level of serum prolactin in patients after surgery is related to tumor size,growth pattern and preoperative prolactin level.Prolactin microadenoma and non-invasive prolactin adenoma of the total resection rate is high,the effect is better.