侵袭性巨大泌乳素腺瘤的综合治疗(附30例报告)

Combined treatment of invasive giant prolactinomas(Report of 30 cases)

目的探讨侵袭性巨大泌乳素腺瘤的综合治疗方法及临床治疗效果。方法纳入侵袭性巨大泌乳素腺瘤(IGPs)的标准是:(1)肿瘤直径>4cm;(2)血浆PRL>200ng/ml;(3)高泌乳素分泌或占位效应引起的临床症状。并根据治疗方式的不同分为两组:A组常规的先给以手术治疗,术后给以药物治疗和/(或)放疗,本组18例;B组先给以药物治疗,或配合放疗,必要时再给以手术治疗,本组12例。结果A组失访5例,其余13例在平均随访的42.5个月内肿瘤体积平均缩小76.5%,而B组在随访的23个月内肿瘤体积平均缩小91.3%;肿瘤在MRI上消失A组6例,B组4例;PRL水平控制在200ng/ml以内者A组7例(7/13),B组8例(8/12);A组视力改善者2例(2/13),而B组视力改善者6例(6/12);平均治疗费用A组明显为高。结论对侵袭性巨大泌乳素腺瘤,可先给以药物,能有效地缩小肿瘤体积和控制PRL水平,部分病例可以达到治愈的目的,从而避免手术风险,降低治疗费用。

Objective To discuss the terapeutic strategy and clinical outcomes of invasive giant prolactinomas (IGPs). Methods The criteria of IGPs includes: (1) tumor diameter>4cm; (2) prolactin level>200ng/ml; (3) clinical signs of hyperprolactinemia/mass effect. According to the difference of initial treatment, they were divided into two groups: Group A: patients underwent surgery initially and then given medical treatment (bromocriptine) and/or radiotherapy (18 cases); Group B: patients initially accepted medical treatment and/or radiotherapy and necessarily given surgery (12 cases). Results In Group A, tumor volume on MRI was decreased on average by 76.5% through the average 42.5month's follow-up. In Group B, tumor volume on MRI was decreased on average by 91.3% through the average 23month's follow-up. Six patients' tumors in Group A disappeared on MRI whereas four patients Group B; There were seven patients in Group A whose prolactin level was controlled less than 200ng/ml whereas eight in Group B; Two patients in Group A had improved in visual symptoms whereas 6 in Group B; It was obvious that the average treatment expenditure of Group A was much higher than that of Group B. Conclusions As to invasive giant prolactinomas, medical treatment may be an optimal and initial choice, which can effectively shrink tumor volume and decrease prolactin level. Majority of the patients can be cured and then avoid the risk of surgery with less expenditure.