垂体泌乳素细胞腺瘤治疗策略的理念改变  

The conceptive shift of therapeutic strategy for prolactinomas

作　　者：吴哲褒[1] 成宜军 张亚卓 WU Zhebao;CHENG Yijun;ZHANG Yazhuo(Department of Neurosurgery,Center of Pituitary Tumor,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Beijing Neurosurgical Institute,Beijing 100005,China)

机构地区：[1]上海交通大学医学院附属瑞金医院神经外科,上海200025 [2]北京市神经外科研究所,北京100005

出　　处：《肿瘤》2024年第9期901-904,共4页Tumor

摘　　要：泌乳素细胞腺瘤是最常见的垂体神经内分泌肿瘤亚型,其治疗手段包括药物、手术和放疗等。对于侵袭和非侵袭的不同类型泌乳素细胞腺瘤,药物和手术何者作为首选治疗,一直存在争议。近10年来,随着神经内镜经蝶窦微创技术的进步,尤其是对垂体瘤假包膜认识的加深,加上卓越垂体瘤中心的建设,使得手术治疗的生化缓解率得到显著提升。对于特定亚型,即微腺瘤和包裹良好和(或)边界清晰的大腺瘤(Knosp分级为0~2级),其神经内镜经蝶窦手术的生化缓解率近90%,与药物治疗疗效相当,可以避免药物不良反应和长期服药的弊端。因此,最近国际垂体协会制定的泌乳素细胞腺瘤诊治共识声明中明确指出:外科手术作为特定亚型泌乳素细胞腺瘤的一线治疗。这一改变以共识的形式确定下来,具有极强的临床指导意义。Prolactinomas are the most common subtype of pituitary neuroendocrine tumors(PitNETs),which can be treated with drugs surgery,radiotherapy and so on.For invasive and noninvasive prolactinomas,there is still controversy on the treatment choice of drugs or surgery as the first-line option.In the past decade,with the progress of endoscopic transsphenoidal minimally invasive technology in-depth understanding of PitNETs pseudocapsule,and constructions of Pituitary Tumor Centers of Excellence(PTCOE),the biochemical remission rate by surgical treatment has been significantly improved.For some specific subtypes of prolactinomas,such as microadenomas and enclosed macroadenomas(Knosp grade 0-2),the biochemical remission rate can achieve 90%with the treatment of endoscopic transsphenoidal surgery,which was similar with the drug efficacy.Therefore,the International Pituitary Society made the latest consensus statement on the clinical treatment of prolactinomas suggested that surgery can be performed as first-line option for some selected prolactinomas.This shift of therapeutic strategy was determined in the form of consensus statement,which has a strong clinical guiding significance.

关 键 词：垂体神经内分泌肿瘤 泌乳素细胞腺瘤 多巴胺受体激动剂 神经内镜经蝶窦微创手术 卓越垂体瘤中心 

分 类 号：R736.4[医药卫生—肿瘤]