van't Verlaat J W
Department of Neurosurgery, University Hospital, Utrecht, The Netherlands.
Acta Endocrinol (Copenh). 1993 Jul;129 Suppl 1:34-7.
Success with trans-sphenoidal surgery for microprolactinomas is good (57 to 93% cure rate) but tumours can recur. Conversely, the results of surgery for macroprolactinomas are not so good (14 to 39% cure rate) and cure is rarely effected when plasma prolactin levels are > 10 U/l. Surgical therapy for prolactinoma should be reserved for patients with dopaminergic resistance or intolerance and complications (e.g. haemorrhage and rhinorrhoea) to dopamine agonist therapy. Trans-sphenoidal surgery was used to treat 11 microprolactinoma patients who had compliance problems to dopaminergic therapy. Postoperative plasma prolactin levels were normal in all patients. During follow-up (range 0.5 to 8 years, mean 3.9 years) six patients remained normoprolactinaemic, four patients developed slightly elevated plasma prolactin levels ( < 0.7 U/l), and one patient developed a macroadenoma resistant to bromocriptine and CV 205-502. He underwent a second operation, followed by radiotherapy and bromocriptine. His plasma prolactin was reduced to 3.3 U/l. One patient with a prolactinoma extending into the left cavernous sinus had a tumour cyst in the left temporal lobe. During treatment with CV 205-502 he developed a haemorrhage in the tumour cyst necessitating craniotomy.
经蝶窦手术治疗微泌乳素瘤的成功率较高（治愈率为57%至93%），但肿瘤可能复发。相反，大泌乳素瘤的手术效果则不太理想（治愈率为14%至39%），当血浆泌乳素水平>10 U/l时，很少能实现治愈。泌乳素瘤的手术治疗应仅用于对多巴胺能药物耐药或不耐受以及出现并发症（如出血和鼻漏）的多巴胺激动剂治疗患者。经蝶窦手术用于治疗11例对多巴胺能治疗依从性差的微泌乳素瘤患者。所有患者术后血浆泌乳素水平均恢复正常。在随访期间（范围为0.5至8年，平均3.9年），6例患者泌乳素水平保持正常，4例患者血浆泌乳素水平略有升高（<0.7 U/l），1例患者出现对溴隐亭和CV 205 - 502耐药的大腺瘤。他接受了第二次手术，随后进行放疗和溴隐亭治疗。其血浆泌乳素水平降至3.3 U/l。1例泌乳素瘤延伸至左侧海绵窦的患者在左侧颞叶有一个肿瘤囊肿。在使用CV 205 - 502治疗期间，他的肿瘤囊肿发生出血，需要进行开颅手术。
