侵袭性垂体泌乳素腺瘤的治疗策略

目的 探讨侵袭性垂体泌乳素腺瘤的治疗策略.方法 纳入侵袭性垂体泌乳素腺瘤的标准是:(1)Knosp分级Ⅲ或Ⅳ级,即肿瘤侵袭海绵窦;(2)血浆泌乳素(PRL)9.1 nmol/L;(3)高PRL分泌症状或占位效应.符合上述标准者80例,其中单纯药物(溴隐亭)治疗21例,首选药物治疗结合手术和(或)放疗组21例,首选手术治疗结合药物和(或)放疗组(首选手术治疗组)38例.残留海绵窦肿瘤行伽玛刀治疗11例.结果 平均随访62个月,MRI检查肿瘤消失57例(71%),其中单纯药物治疗组12例,首选药物治疗结合手术和放疗组16例,首选手术治疗组29例.其余23例残留肿瘤均在鞍旁海绵窦内.PRL水平正常者52例(65%),其中首选手术治疗组31例,单纯药物治疗组10例.PRL9.1 nmol/L者7例.视力改善者33例,与治疗前一致者40例,恶化7例.垂体功能低下者9例.结论 对侵袭性泌乳素腺瘤,提倡以多巴胺受体激动剂为首选治疗的个体化治疗方案.手术后仍要服用溴隐亭并进行密切随访观察.海绵窦残留肿瘤可以行伽玛刀治疗.

Treatment strategy of pituitary invasive prolactinomas

Objective To discuss the treatment strategy of invasive prolactinomus (Ips) involving the cavernous sinus. Methods Data from 80 patients with Ips treated in our institutions were reviewed retrospectively. The criteria utilized included: (1) invasion of the cavernous sinus by tumor, corresponding to Grade Ⅲ-Ⅳ according to the classification of Knosp; (2) serum prolactin level 9.1 nmol/L; (3) clinical signs of hyperprolactinemia and mass effect. Among the 80 patients who met the criteria: 21 patients received bromocriptine as primary treatment( Group A) ; 21 patients initially received bromocriptine and then accepted microsurgery or irradiation (Group B ); 38 patients had initially undergone transcranial or transsphenoidal microsurgery and then received bromocriptine or adjuvant radiotherapy (Group C). Eleven patients underwent gamma knife radiotherapy. Results In 57 patients ( 12 cases of Group A, 16 cases of Group B, 29 cases of Group C), the tumors on MRI had almost completely disappeared after an average follow-up period of 62 months, and in the other 23 patients, residual tumor involved the cavernous sinus. Visual symptoms improved in 33 patients while deteriorated in 7 patients. Serum prolactin level of 52 patients had in normal range after treatment ( 10 cases of Group A, 11 cases of Group B, 31 cases of Group C) and 7 patients were more than 9. 1 nmol/L Nine patients had symptoms of hypopitnitarism. Conclusions For Ips, individualized treatment methods are advocated in which dopamine agonist medications are effective as first-line therapy. It is necessary to take dopamine agonist after operation and close observation is mandatory. Gamma knife surgery is an option to treat the residual tumor involving the cavernous sinus.