神经内镜经鼻手术治疗垂体催乳素细胞肿瘤的临床疗效分析  

Analysis of clinical efficacy of transnasal neuroendoscopic surgery for prolactin-secreting tumors of the pituitary gland

作　　者：李储忠[1] 郭靖 桂松柏[2] 白吉伟[2] 曹磊[2] 刘春晖[2] 朱海波[2] 李振业[2] 张亚卓[1] Li Chuzhong;Guo Jing;Gui Songbai;Bai Jiwei;Cao Lei;Liu Chunhui;Zhu Haibo;Li Zhenye;Zhang Yazhuo(Bejing Neurosurgical Institute,Capital Medical University,Bejing 100070,China;Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学,北京市神经外科研究所,北京100070 [2]首都医科大学附属北京天坛医院神经外科学中心,北京100070

出　　处：《中华神经外科杂志》2023年第11期1092-1096,共5页Chinese Journal of Neurosurgery

基　　金：北京市自然科学基金(Z220012)。

摘　　要：目的探讨神经内镜经鼻手术治疗垂体催乳素(PRL)细胞肿瘤的临床疗效.方法回顾性分析2008年2月至2018年1月首都医科大学附属北京天坛医院神经外科学中心行神经内镜经鼻手术治疗的202例PRL细胞肿瘤患者的临床资料.其中微小型肿瘤6例,大型152例,巨大型44例;术前多巴胺受体激动剂(DA)耐药62例,无法耐受药物不良反应17例.术后通过头颅MRI检查评估肿瘤的切除程度;通过血清PRL水平评估内分泌治愈情况及减瘤手术对药物应用情况的影响;术后3、6、12个月及每年对患者的临床症状、体格检查、影像学检查及内分泌实验室检查进行随访;比较大型、巨大型PRL细胞瘤的临床治疗效果.结果202例患者的神经内镜手术均顺利完成,肿瘤全切除128例(63.3%),次全切除45例(22.3%),大部分切除21例(10.4%),部分切除8例(4.0%).术后发生脑脊液鼻漏1例(0.5%),视力下降2例(1.0%),颈内动脉损伤1例(0.5%),一过性尿崩38例(18.8%).192例患者获得临床随访,随访时间[M(Q_(1),Q_(3))]为70.5(55.0,86.0)个月.末次随访显示,113例(58.9%)患者获得内分泌治愈,12例(6.3%)肿瘤复发,1例(0.5%)死亡.62例术前耐药患者中,28例(45.2%)获得生化缓解,9例(14.5%)转为药物敏感;17例术前无法耐受药物不良反应患者中,13例获得生化缓解,3例转为药物耐受.与巨大型肿瘤相比,大型肿瘤的全切除率高、术后并发症发生率低,差异均有统计学意义(均P<0.05);而术后临床症状改善率、末次随访时内分泌治愈率、肿瘤复发率的差异均无统计学意义(均P>0.05).结论神经内镜经鼻手术治疗可使大部分PRL细胞肿瘤患者获得治愈或缓解,也可使部分患者由DA耐药转为敏感或由不耐受转为耐受,可作为部分PRL细胞肿瘤治疗的首选.Objective To explore the clinical efficacy of neuroendoscopic transnasal surgery for the treatment of prolactinomas.MethodsA retrospective study was conducted on the clinical data of 202 cases of prolactinomas who underwent neuroendoscopic surgery in the Neurosurgery Center of Beijing Tiantan Hospital,Capital Medical University from February 2008 to January 2018.Among them,there were 6 cases of micro-tumors,152 cases of macro-tumors,and 44 cases of giant tumors;62 cases were resistant to preoperative dopamine receptor agonists(DA);17 cases were unable to tolerate adverse drug reactions.After surgery,the extent of tumor resection was evaluated based on brain MRI,and the endocrine outcome and the effect of tumor reduction on drugs were evaluated based on the serum prolactin levels.The clinical symptoms,physical examination,brain MRI,and endocrine laboratory examinations of the patients were monitored at 3,6 and 12 months post surgery,as well as annually thereafter.This allowed for a comparison of the clinical treatment outcomes between large and giant tumors.Results Neuroendoscopic surgeries were successfully performed on all 202 patients.Complete tumor resection was achieved in 128 cases(63.3%),while subtotal resection,major resection,and partial resection were observed in 45 cases(22.3%),21 cases(10.4%),and 8 cases(4.0%),respectively.Postoperative complications included cerebrospinal fluid rhinorrhea in 1 case(0.5%),vision loss in 2 cases(1.0%),internal carotid artery injury in 1 case(0.5%),and transient diabetes insipidus in 38 cases(18.8%).A total of 192 patients underwent clinical follow-up,with a median(Q_(1),Q_(3))period of 70.5(55.0,86.0)months.The final follow-up revealed that 113 patients(58.9%)had normal prolactin level,while 12 patients(6.3%)experienced tumor recurrence and 1 patient(0.5%)succumbed to the disease.Of the 62 patients with preoperative drug resistance,28(45.2%)achieved biochemical remssion and 9(14.5%)became drug sensitive.Among the 17 patients who could not tolerate adverse drug reactions

关 键 词：催乳素瘤 多巴胺激动剂 自然腔道内镜手术 治疗结果 耐药 

分 类 号：R736.4[医药卫生—肿瘤]