Reasons and results of endoscopic surgery for prolactinomas: 142 surgical cases
Reasons and results of endoscopic surgery for prolactinomas: 142 surgical cases
复制标题
DOI：
10.1007/s00701-016-2762-z
复制
发表时间：
2016-05-01
影响因子：
2.4
通讯作者：
Berker, Mustafa
中科院分区：
文献类型：
--
作者：
Akin, Safak;Isikay, Ilkay;Berker, Mustafa
我们在此报告回顾性分析了142例连续的催乳素瘤病例的结果，这些病例均经鼻内窥镜经蝶窦入路手术。在平均36个月的随访期间，对142例病例的医疗记录进行了分析，包括手术指征、住院时间、早期缓解率、失败率和复发率。磁共振成像（MRI）资料显示，微腺瘤19例（13.4%），大腺瘤113例（79.6%），巨大腺瘤10例（7.0%）。25例患者通过MRI发现海绵窦侵犯，并在手术中证实。非典型腺瘤16例。稀粒性泌乳素腺瘤99例（69.7%）。我们的研究结果表明，男性和术前较高的催乳素水平是预测持续疾病的独立因素。术后并发症发生率为：脑膜炎2.8%，脑脊液漏2.1%，全垂体功能低下2.1%。随访结束时，74.6%的患者病情缓解。在随访期间，5例最初缓解的患者出现复发。我们的研究和文献资料表明，经鼻内窥镜经蝶窦入路治疗泌腺素瘤有良好的缓解率。根据这项研究的结果，内镜下经鼻蝶窦手术可能是一种合适的治疗选择，患者的催乳素瘤不能管理推荐的治疗方式。
We report herein a retrospective analysis of the results of 142 consecutive prolactinoma cases operated upon using an endoscopic endonasal trans-sphenoidal approach over a period of 6 years.Medical records of 142 cases were analysed with respect to indications for surgery, duration of hospital stay, early remission rates, failures and recurrence rates during a median follow-up of 36 months.On the basis of magnetic resonance imaging (MRI) data, 19 patients (13.4 %) had microadenoma, 113 (79.6 %) had macroadenoma, and the remaining 10 (7.0 %) had giant adenomas. Cavernous sinus invasion was identified in 25 patients by MRI and confirmed during surgery. Atypical adenoma was diagnosed in 16 patients. Sparsely granulated prolactin adenoma was identified in 99 patients (69.7 %). Our results demonstrate that male sex and higher preoperative prolactin levels are independent factors predicting persistent disease. The post-surgical complications are as follows: 2.8 % patients had meningitis, 2.1 % patients had postoperative cerebrospinal fluid leak and 2.1 % patients had panhypopituitarism. At the end of follow-up, 74.6 % patients went into remission. During follow-up period, five patients who had initial remission developed recurrence.Our series together with literature data suggest that an endoscopic endonasal trans-sphenoidal approach in the treatment of proloctinomas has a favourable rate of remission. According to the findings of this study, endoscopic endonasal trans-sphenoidal surgery might be an appropriate therapy choice for patients with prolactinoma who could not have been managed with recommended therapeutic modalities.