垂体泌乳素腺瘤的诊断与治疗附124例临床分析

背景与目的：垂体泌乳素腺瘤在垂体分泌性腺瘤中所占比率较高，临床治疗观点各家不一。本文分析总结了垂体泌乳素腺瘤的诊断和治疗特点。方法：对5年间124例垂体泌乳素腺瘤病例的临床表现、内分泌学、影像学特点及治疗、预后情况进行回顾性分析。结果：垂体泌乳素腺瘤男性患者以视力减退、视野缺损、性功能障碍多见；女性以月经异常、溢乳多见。手术组平均血清泌乳素（prolactin，PRL）水平男性1875．22μg／L，女性376．6μg／L。男性肿瘤直径平均38.05mm，其中83.3％肿瘤呈侵袭性生长，在女性则为15.25mm和49％。术后，男性PRL降至385.84斗g／L（P〈0.05），15例性功能障碍者13例改善，82．6％的视力视野障碍得到改善；女性PRL降至23.93μg/L，（P〈0.05）。微腺瘤不孕者术后受孕率达81.25％，高于药物治疗组33.33％（P〈0.05）。结论：男性患者具有发病年龄高、肿瘤大且呈侵袭性生长、泌乳素水平高等特点。而女性有发病年龄较低，多为微腺瘤，手术治疗后泌乳素水平控制率高，不孕患者受孕率高等特点。我们提倡以手术治疗为主的综合治疗。

Diagnosis and Treatment of Prolactinomas: Analysis of 124 Cases

BACKGROUND & OBJECTIVE: Pituitary prolactinoma is one of the most common pituitary adenomas, and treatment strategies were still controversial. This study was to analyze the diagnostic and therapeutic features of prolactinomas. METHODS: Clinical manifestations, endocrinological, radiographic and therapeutic features of 124 patients with prolactinomas were retrospectively analyzed. RESULTS: The average age of the male patients was 41.6 years old, and 32.3 years old of females. The major clinical manifestations in males were sexual and visual defects, and dysfunction of menstruates and galactorrhea in females. The Average level of serum prolactin was 1875.22 ng/ml in males and 376.6ng/ml in females. The average diameter of the tumor was 38.05mm in males, and 83.3% of the tumors were invasive. In females, the average diameter of tumors was 15.25mm and 49% of them were invasive. After surgery, in males, the average level of serum prolactin decreased to 385.84ng/ml (P<0.05), and 13 of the 15 patients improved in sexual function, 82.6% of the cases improved in visual acuity and visual field. In the females, prolactin decreased to 23.93ng/ml (P<0.05), and 81.25% of the infertile cases with microprolactinoma became pregnant, higher than those of patients treated with drug administration (P<0.05). CONCLUSIONS: In males, the tumors were usually large and invasive and the serum prolactin level was high. The patients were older. In females, the age was much younger than that of males, most of the tumors were microadenomas, and after operation the prolactin usually decreased to the normal level. Because any single therapy is not satisfactory, operation with multimodal treatment is advocated.