Jan M, Dufour H, Brue T, Jaquet P
Department of Neurosurgery, Bretonneau Regional University Teaching Hospital, 2 Bd Tonnellé, 37044 Tours cedex, France.
Ann Endocrinol (Paris). 2007 Jun;68(2-3):118-9. doi: 10.1016/j.ando.2007.03.011. Epub 2007 May 21.
Surgery is generally used as second-line treatment in prolactinomas. For microprolactinomas, it may be indicated in cases of resistance or intolerance to dopamine agonists or where patients prefer definitive cure to lifelong drug treatment. In highly trained hands, selective adenomectomy results in normalization of prolactin levels in 75-90% of cases with little morbidity and no mortality. However, subsequent relapse is possible in up to 20% of cases. In macroprolactinoma, a definitive cure is unlikely due to the frequency of invasive tumor extension. A transsphenoidal or, less frequently, a transfrontal surgical approach is necessary in patients resistant to or intolerant of medical treatment, and also in rare cases such as pituitary apoplexy or cerebrospinal fluid rhinorrhea.
手术通常用作泌乳素瘤的二线治疗。对于微泌乳素瘤，在对多巴胺激动剂耐药或不耐受的情况下，或者患者更倾向于彻底治愈而非终身药物治疗的情况下，可能会考虑手术。在经验丰富的医生手中，选择性腺瘤切除术可使75%至90%的病例泌乳素水平恢复正常，且发病率低，无死亡率。然而，高达20%的病例可能会随后复发。对于大泌乳素瘤，由于侵袭性肿瘤扩展的频率较高，不太可能实现彻底治愈。对于耐药或不耐受药物治疗的患者，以及垂体卒中或脑脊液鼻漏等罕见情况，需要采用经蝶窦手术，或较少采用的经额手术入路。
