女性垂体泌乳素微腺瘤的治疗方式  

A clinical study of conservative vs surgical treatment of female pituitary microprolactinoma

作　　者：殷怡华[1] 魏美娟[2] 冯令达[1] 李士其[3] 

机构地区：[1]同济大学附属第一妇婴保健院,上海200040 [2]复旦大学附属妇产科医院 [3]复旦大学附属华山医院

出　　处：《上海医学》2008年第2期83-86,共4页Shanghai Medical Journal

摘　　要：目的对育龄期女性垂体泌乳素微腺瘤患者药物与手术治疗的疗效、不良反应及并发症进行比较。方法回顾性分析2004年1月—2006年6月确诊为垂体泌乳素微腺瘤的女性患者88例,根据治疗方法分为两组,药物组26例,手术组62例。随访各组治疗前、后的临床症状变化、内分泌激素水平以及生殖生育情况,并对其疗效进行评价。结果总治疗有效率为73.9%,其中药物组为69.2%,手术组为75.8%,两组问差异无统计学意义(P>0.05)。治疗后总受孕率为12/19,活胎率为10/19。药物组活胎率为7/8,明显高于手术组的3/11 (P<0.05)。药物不良反应发生率为53.8%,手术并发症发生率为24.2%。多因素回归分析显示,药物治疗后1个月泌乳素(PRL)水平是否立即恢复正常、术前PRL值/术后1 d PRL值是否≥20是预测疗效的独立危险因素。结论有生育要求的垂体泌乳素微腺瘤患者应首选药物治疗。治疗后应定期随访PRL水平以及时调整治疗方案。治疗后的1～3个月对于有生育要求的患者是关键期。Objective To compare the effects of conservative and surgical treatments of microprolactinoma in women of reproductive age. Methods A retrospective analysis was conducted in 88 patients with pituitary microprolactinoma, who received either conservative treatment with medication（n = 26） or surgical treatment （n=62）. All the patients were followed up to observe the changes in clinical manifestations and hormonal profiles with the pregnancies and child birth recorded. The effects of the treatments were evaluated in line with the criteria of Peking Union Medical College. Results The overall effective rate of the treatments was 73.9 %, and the effective rate was 69.2% with drug treatment and 75.8% with surgical treatment; there was no significant difference between the two treatments. The overall pregnancy rate after treatment was 12/19, with a live birth rate of 10/19. Conservative treatment with medications was associated with a significantly higher live birth rate than surgical treatment （7/8 vs 3/11, P 〈 0.05）, as well as a significantly higher pregnancy rate. Adverse effects occurred in 53.8% of the patients having conservative treatment with medications, and 24. 2% patients undergoing surgical treatment had postoperative complications. Multivariate regression analysis indicated that prolectin recovery within 1 week after medication and prolectin declination by over 20 folds one day after surgery were the independent risk factors for predicting the clinical outcome of the treatments. Conclusion Drug treatment should be the first choice for women planning to have pregnancy, and regular prolectin measurement after treatment is suggested for timely modification of the treatments. The first 3 months following the treatment is the critical period for microprolactinoma patients who plan to have pregnancies.

关 键 词：垂体泌乳素微腺瘤 药物治疗 手术治疗 

分 类 号：R736.4[医药卫生—肿瘤]