目的 探讨伽玛刀联合溴隐亭在治疗育龄女性垂体泌乳素大腺瘤患者中的临床疗效.方法 对37例垂体泌乳素大腺瘤患者应用伽玛刀联合溴隐亭治疗,术后进行24个月的随访,对泌乳素水平、肿瘤控制情况、妊娠情况及并发症进行评估.结果 至随访期结束,22例(59.46%)患者泌乳素水平降至正常范围,14例(37.84%)患者处于妊娠期、哺乳期或妊娠终止的泌乳素水平,1例(2.70%)患者无法耐受溴隐亭副作用泌乳素仍高于正常.影像学上,所有患者肿瘤中心均出现不同程度坏死,14例(37.84%)病灶缩小或消失,23例(62.16%)病灶大小无变化.33例(89.19%)患者在治疗后平均(10.6±3.8)个月获得妊娠,妊娠期间及生产后肿瘤未见增大.3例(8.1%)患者出现妊娠期间及妊娠后甲状腺功能减低.结论 伽玛刀联合溴隐亭能有效控制垂体泌乳素大腺瘤生长,恢复育龄女性患者生育能力,可作为一种安全的治疗方法.%Objective To explore the therapeutic effect of Gamma knife radiosurgery(GKS)combined with bromocriptine for infertile woman patients with macro-prolactinoma. Methods 37 cases received the therapy and followed up for at least 24 months. Patients' serum prolactin level, tumor size,pregnancy rates and complicaitons were assessed. Results 22(59.46%)patients' serum prolactin level fell to the normal range, 14(37.84%)cases were in pregnancy,lactation or pregnancy ceased level at the end of follow up period,1(2.70%)case was still above normal level for the untolerance of bromocriptine's side effect. In MRI manifestation,different degrees of necrosis in the center of the adenoma were found in all cases,nidus retreated or disappear in 14(37.84%)cases and not changed in 23(62.16%)cases. 33(89.19%)patients were pregnant mean (10.6±3.8)months after the therapy,no significant enlargement in tumor volume during pregnancy were found. Hypothyroidism appear in 3(8.1%) patients during and after pregnancy. Conclusion GKS combined with bromocriptine could be a suggested method for the treatment of infertile woman patients with macro-prolactinoma.
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