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目的:探讨侵袭性巨大催乳素瘤的诊治方法及效果。方法:回顾分析我院收治的侵袭性巨大催乳素瘤18例,均经头颅MR I和内分泌检查确诊。纳入标准:(1)肿瘤直径>4 cm;(2)血浆PRL>200ng/mL;(3)高催乳素分泌或占位效应引起的临床症状。手术治疗15例,术后给以药物(溴隐亭)治疗,结合放疗。非手术治疗3例,先药物(溴隐亭)治疗,结合放疗。结果:手术组随访12例,平均随访29.5mo,肿瘤体积缩小75%;非手术组随访3例,在平均随访的24mo内肿瘤体积缩小80%;肿瘤消失各l例。PRL控制在200ng/mL以下手术组6例,非手术组2例;视力视野改善手术组6例,非手术组2例。结论:对侵袭性巨大催乳素瘤可首选药物治疗,能有效地缩小肿瘤体积和控制PRL水平,部分可达治愈的目的,从而避免手术风险。早期手术仅适用于视力视野明显急剧下降者,肿瘤卒中引起显著临床症状者,服药不能耐受或耐药者,服药出现脑脊液漏需修补者。
Objective: To explore the diagnosis and treatment of aggressive giant prolactinoma and its effects. Methods: Retrospective analysis of 18 cases of aggressive giant prolactinoma admitted to our hospital, were confirmed by head MRI and endocrine examination. Inclusion criteria: (1) tumor diameter> 4 cm; (2) plasma PRL> 200 ng / mL; (3) high prolactin secretion or placeholder effect caused by clinical symptoms. Surgical treatment in 15 cases, after surgery to drug (bromocriptine) treatment, combined with radiotherapy. Non-surgical treatment in 3 cases, the first drug (bromocriptine) treatment, combined with radiotherapy. Results: In the operation group, 12 cases were followed up for an average of 29.5 months. The tumor volume was reduced by 75%. In non-operation group, the tumor size was reduced by 80% in 24 months. The tumor disappeared in 1 case. PRL was controlled below 200ng / mL in 6 cases in operation group and 2 cases in non-operation group; 6 cases in visual field improvement group and 2 cases in non-operation group. Conclusion: The first choice of drug therapy for aggressive giant prolactinoma can effectively reduce the tumor volume and control the PRL level, and some of them can reach the goal of cure, thus avoiding the operation risk. Early surgery only applies to significantly decreased visual field sharp decline in those who cause significant clinical symptoms of stroke, medication can not tolerate or resistant to those who take cerebrospinal fluid leakage need to be repaired.