侵袭性巨大催乳素瘤的诊治

目的：探讨侵袭性巨大催乳素瘤的诊治方法及效果。方法：回顾分析我院收治的侵袭性巨大催乳素瘤18例，均经头颅MRI和内分泌检查确诊。纳入标准：（1）肿瘤直径〉4cm；（2）血浆PRL〉200ng／mL；（3）高催乳素分泌或占位效应引起的临床症状。手术治疗15例，术后给以药物（溴隐亭）治疗，结合放疗。非手术治疗3例，先药物（溴隐亭）治疗，结合放疗。结果：手术组随访12例，平均随访29．5mo，肿瘤体积缩小75％；非手术组随访3例，在平均随访的24mo内肿瘤体积缩小80％；肿瘤消失各1例。PRL控制在200ng／mL以下手术组6例，非手术组2例；视力视野改善手术组6例，非手术组2例。结论：对侵袭性巨大催乳素瘤可首选药物治疗，能有效地缩小肿瘤体积和控制PRL水平，部分可达治愈的目的，从而避免手术风险。早期手术仅适用于视力视野明显急剧下降者，肿瘤卒中引起显著临床症状者，服药不能耐受或耐药者，服药出现脑脊液漏需修补者。

DIAGNOSIS AND TREATMENT OF INVASIVE GIANT PROLACTINOMA

Objective:To discuss methods of diagnosis and treatment and clinical outcome of invasive giant prolactinoma(IGP).Methods:To summarize 18 cases of IGP in our hospital which were got confirmed diagnosis with MRI and endocrine examination.The criteria of IGP includes:(1) tumor diameter>4cm;(2) prolactin level>200ng/mL;(3) clinical signs of hyperprolactinemia/mass effect.15 patients underwent surgery and then were given medicinal treatment(bromocriptine) and radiotherapy.3 patients didn't undergo surgery which were initially given medicinal treatment combining with radiotherapy.Results:In 12 cases of group operation,tumor volume was decreased on average by 75% through the average 29.5 month's follow-up.In 3 cases of group non-operation,tumor volume was decreased on average by 80% through the average 24 month's follow-up.In 1 case of each group,the tumor disappeared.There were 6 cases in group operation whose prolactin level was controlled less than 200ng/mL whereas 2 cases in group non-operation.Six cases in group operation had improved in visual acuity and visual field whereas 2 cases in group non-operation,Conclusion:As to IGP,medicinal 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.Early operation is suitable for the patients with sharp aggravations of visual acuity and visual field.It's also suitable for the patients with tumor hemorrhage and remarkable clinical symptoms,for the patients which can't bear medicinal therapy or with drug resistance,for the patients with cerebrospinal rhinorrhea and otorrhea and need repaired.