催乳素微腺瘤经蝶手术、溴隐亭与伽玛刀治疗的对比研究
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摘要
目的:探讨经蝶窦显微外科手术、溴隐亭及伽玛刀治疗三种治疗方法对垂体催乳素微腺瘤的疗效,提出其规范化治疗方案。
材料与方法:
120例垂体催乳素微腺瘤的女性患者,按照接受经蝶显微外科手术、药物(溴隐亭)及伽玛刀治疗三种治疗方法分组,每组40例,年龄16～40岁。比较三种治疗方法在降低催乳素水平、治愈率、有效率、复发率、并发症发生率、治疗费用及患者对治疗方法的满意度等方面的差异,并做相应的统计学处理。
结果:
1、三组治疗后的催乳素水平在1个月、6个月、24个月均有显著性差异(P<0.001),每组治疗前后的催乳素水平亦有显著性差异(P<0.001);
2、三组的治愈率、有效率有显著差异(P<0.001,P=0.001);
3、三组的复发率有显著性差异(P<0.001);
4、三组的并发症发生率有显著性差异(P<0.001)。
5、三组治疗费用有显著性差异(P<0.001);
6、患者对三种疗法的满意度有显著性差异(P<0.001)。
结论:
1.三种治疗方法对垂体催乳素微腺瘤有效,经蝶窦显微外科手术治疗是最理想的治疗方式,溴隐亭次之,伽玛刀第三;我们术中发现有1/3患者的肿瘤包绕垂体生长,范围广。我们认为此是伽玛刀效果对某些病例的疗效不够满意的一个重要原因。
2.对年轻的,想迅速治愈肿瘤的,想生育的,不愿长期吃药的垂体催乳素微腺瘤患者我们推荐首选经蝶手术治疗。年龄较大且愿意长期服药者,我们推荐首选药物治疗。
3.对催乳素微腺瘤患者,我们不推荐首选伽玛刀治疗;对不愿手术,又不愿药物治疗而临床症状明显者,可考虑行伽玛刀治疗。
Objective: To discuss the effects of three different treatments, transsphenoidal microsurgery, bromocriptine and gamma knife, on pituitary microprolactinoma and to propose a standardized treatment project.Methods: 120 female patients (16~40y) with microprolactinoma were divide into three groups. Each group (n=40) accepted one of the upper mentioned treatments (transsphenoidal microsurgery, bromocriptine or gamma knife) respectively. Then we compared the effects of the three treatments by comparing the prolactin levels, healing rates, effective rates, recurrence rates, incidence of relative complications, therapeutic costs and satisfactory degrees of patients. Statistical analysis was performed at last. Results:1. The difference of prolactin levels in three groups was statistically significant (p <0. 001) in 1 month, 6 months, 24 months respectively. The difference of prolactin levels before treatment and after treatment was statistically significant too (p < 0.001) .2. The curative rates and effective rates among three groups were significantly different (p < 0. 001, p = 0. 001) .3. The difference of the recurrence rates among three groups were statistically significant (p < 0.001) .4. The incidence rates of relative complications among three groups were significantly different (p < 0.001) .5. The average therapeutic costs of the three groups were statistically significant (p < 0.001) .6. The average satisfactory degrees of the three groups were statistically significant(p< 0.001) . Conclusion: 1. All of the three treatments are effective on prolactinoma, while the effect of
microsurgery is the best. Bromocriptine and Gamma knife took the 2nd and the 3rd positions respectively according to their effects. In 1/3 of all the operations we found the pituitaries were surrounded by big tumors. We suppose that is one of the important reasons why the effect of gamma knife is not always satisfying in some cases.2. Transsphenoidal microsurgery is recommended to young patients who want to cure tumor as quickly as possible, patients who plan to bear children, or patients who are reluctant to take medicine for long time. Pharmaceutical therapy is recommended to patients who are older and willing to take medicine.3. We hesitate to recommend Gamma knife to patients with microprolactinoma. But we can consider Gamma knife when patients' symptom is visible and when patients are reluctant to accept transsphenoidal microsurgery or pharmaceutical therapy.
材料与方法:
120例垂体催乳素微腺瘤的女性患者,按照接受经蝶显微外科手术、药物(溴隐亭)及伽玛刀治疗三种治疗方法分组,每组40例,年龄16～40岁。比较三种治疗方法在降低催乳素水平、治愈率、有效率、复发率、并发症发生率、治疗费用及患者对治疗方法的满意度等方面的差异,并做相应的统计学处理。
结果:
1、三组治疗后的催乳素水平在1个月、6个月、24个月均有显著性差异(P<0.001),每组治疗前后的催乳素水平亦有显著性差异(P<0.001);
2、三组的治愈率、有效率有显著差异(P<0.001,P=0.001);
3、三组的复发率有显著性差异(P<0.001);
4、三组的并发症发生率有显著性差异(P<0.001)。
5、三组治疗费用有显著性差异(P<0.001);
6、患者对三种疗法的满意度有显著性差异(P<0.001)。
结论:
1.三种治疗方法对垂体催乳素微腺瘤有效,经蝶窦显微外科手术治疗是最理想的治疗方式,溴隐亭次之,伽玛刀第三;我们术中发现有1/3患者的肿瘤包绕垂体生长,范围广。我们认为此是伽玛刀效果对某些病例的疗效不够满意的一个重要原因。
2.对年轻的,想迅速治愈肿瘤的,想生育的,不愿长期吃药的垂体催乳素微腺瘤患者我们推荐首选经蝶手术治疗。年龄较大且愿意长期服药者,我们推荐首选药物治疗。
3.对催乳素微腺瘤患者,我们不推荐首选伽玛刀治疗;对不愿手术,又不愿药物治疗而临床症状明显者,可考虑行伽玛刀治疗。
Objective: To discuss the effects of three different treatments, transsphenoidal microsurgery, bromocriptine and gamma knife, on pituitary microprolactinoma and to propose a standardized treatment project.Methods: 120 female patients (16~40y) with microprolactinoma were divide into three groups. Each group (n=40) accepted one of the upper mentioned treatments (transsphenoidal microsurgery, bromocriptine or gamma knife) respectively. Then we compared the effects of the three treatments by comparing the prolactin levels, healing rates, effective rates, recurrence rates, incidence of relative complications, therapeutic costs and satisfactory degrees of patients. Statistical analysis was performed at last. Results:1. The difference of prolactin levels in three groups was statistically significant (p <0. 001) in 1 month, 6 months, 24 months respectively. The difference of prolactin levels before treatment and after treatment was statistically significant too (p < 0.001) .2. The curative rates and effective rates among three groups were significantly different (p < 0. 001, p = 0. 001) .3. The difference of the recurrence rates among three groups were statistically significant (p < 0.001) .4. The incidence rates of relative complications among three groups were significantly different (p < 0.001) .5. The average therapeutic costs of the three groups were statistically significant (p < 0.001) .6. The average satisfactory degrees of the three groups were statistically significant(p< 0.001) . Conclusion: 1. All of the three treatments are effective on prolactinoma, while the effect of
microsurgery is the best. Bromocriptine and Gamma knife took the 2nd and the 3rd positions respectively according to their effects. In 1/3 of all the operations we found the pituitaries were surrounded by big tumors. We suppose that is one of the important reasons why the effect of gamma knife is not always satisfying in some cases.2. Transsphenoidal microsurgery is recommended to young patients who want to cure tumor as quickly as possible, patients who plan to bear children, or patients who are reluctant to take medicine for long time. Pharmaceutical therapy is recommended to patients who are older and willing to take medicine.3. We hesitate to recommend Gamma knife to patients with microprolactinoma. But we can consider Gamma knife when patients' symptom is visible and when patients are reluctant to accept transsphenoidal microsurgery or pharmaceutical therapy.
引文
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[2] 周良辅 主编.现代神经外科学.上海:复旦大学出版社.2001:523.
[3] Faglia G. Epidemiology and pathogenesis of pituitary adenomas. Acta Endocrinol. 1993, 129(Suppl. 1): 1-5
[4] Davis JR, Farrel WE, Clayton RN. Pituitary tumours. Reproduction, 2001,121(3):363-371
[5] Popovic V, Damjonavic S, Micic D, et al. Increased incidence of neoplasia in patients with pituitary adenomas. The Pituitary Study Group. Clin Endocrinol. 1998, 49(4): 441-445
[6] 程金华,张玉荣,王秀春.垂体泌乳素瘤的诊治探讨.中国实用妇科与产科杂志.2002,18(9):569-570
[7] 付俊生,陈达丽.高泌乳血症与垂体瘤的治疗体会.贵州医药.2003,27:649-650
[8] 陈星星.溴隐亭治疗垂体催乳素瘤.新药与临床.1997,16(5):298-300
[9] 陈闽.血清PRL水平及肿瘤体积对垂体泌乳素瘤疗效的影响.实用医学杂志.2001,17(9):832-833
[10] 潘力,张南.垂体腺瘤的立体定向放射外科治疗.中国微侵袭神经外科杂志.2001,(6):82-85
[11] 王美华,刘鹏,刘阿力.等.伽玛刀治疗生长激素型垂体腺瘤的临床疗效观察.中华医学杂志.2003,83(23):2045-2048
[12] 陈琳,刘宗惠,周东学.等.垂体腺瘤的伽玛刀放射外科治疗.解放军医学杂志.2004,29(3):280
[13] 王守森,陈素,王如密.立体定向放射外科治疗的临床研究.中国微侵袭神经外科杂志.2004,19(1):9-13
[14] 伍炜,应克明,马绍峰.伽玛刀治疗垂体腺瘤218例报告.立体定向和功能神经外科杂志.2003,16(4):225-226
[15] 郭欲天,李鹏程,李晓钟,等.伽玛刀治疗垂体腺瘤的疗效分析.立体定向 和功能神经外科杂志.2003,16(3):155-156
[16] 秦坤明.伽玛刀治疗垂体腺瘤.广西医学.200325(10):1861-1863
[17] 陈永严,常义,刘翔.伽玛刀治疗垂体腺瘤159例疗效分析.中华神经外科疾病研究杂志.2002,1(3):220-223
[18] 鲍伟民,秦志勇,周良辅,等.立体定向伽玛刀治疗垂体腺瘤56例报告.中华神经外科杂志.1997,13(2):76-78
[19] 梁军潮,王伟民,徐如祥,等.伽玛刀治疗功能性垂体腺瘤118例及随访报告.实用医学杂志.2001,17(3):241-242
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