药物治疗无效的垂体泌乳素腺瘤经蝶窦入路手术治疗疗效分析

Therapeutic Effect Analysis of Drug Invalid Prolactinoma with Transphenoid Approach Microsurgical Operation

目的总结垂体泌乳素腺瘤的手术疗效。方法回顾性分析笔者医院61例药物治疗无效而行手术治疗的垂体泌乳素腺瘤患者的临床资料。结果男性患者12例,女性患者49例,患者平均年龄25.7岁,平均病程42.8个月。临床主要表现为女性月经紊乱或男性性功能障碍28例(45.9%)、头痛33例(54.1%)、视物模糊26(42.6%)例等。术前血清泌乳素水平在6.45~9325.32ng/ml,肿瘤最大直径5~80mm,鞍上生长伴视交叉上抬占42.3%,均行经鼻蝶窦入路垂体腺瘤切除术。术后初始完全缓解41例(67.2%),部分缓解20例(32.8%),长期随访中完全缓解32例,复发5例。术后并发症包括暂时性尿崩症30例(49.2%),术后新出现垂体功能低下2例(3.3%)。结论手术治疗对于药物治疗无效的泌乳素瘤患者具有较好的治疗效果,对于肿瘤体积较小及无周围组织侵袭的患者选择手术治疗有望明显改善患者预后,更适合于不想终身服药的患者。

Objective To summarize the operation therapeutic effect of drug invalid prolactinoma. Methods Totally 61 cases of drug invalid prolactinoma patients who took the operation were reviewed retrospectively. Results There were 12 males and 49 females, and the average age was 25.7, and the average course of the disease was 42.8 months. The main clinical manifestation was paramenia and male sexual dysfunction （45.9%）, headache （54. 1% ）, diminution of vision （42.6%） and so on. The preoperative serum prolactin was between 6.45 - 9325.32ng/ml, the maximum diameter of the tumors was between 5 - 80mm, the suprasellar tumor with optic chiasma compression was 42.3%. All of them were taken the transsphenoid approach microsurgical operation. 41 cases （67.2%） were initial complete remission, 20 cases（32.8% ） were partial complete remission, 31 cases were long - term complete remission, and 5 cases were recurrence. The postoperative complication was temporal diabetes insipidus （49.2%） , of which 2 cases were hypopituitarism. Conclu- sion Transsphenoid microsurgical operation is more effective in drug invalid prolactinoma patients. It can make a better progress in progno- sis in microadenoma and non -invasive pituitary adenoma patients, and it is more suitable in the patients who resist medicine therapy.