摘要
目的探讨妊娠合并垂体泌乳素腺瘤(prolactin-secreting adenoma,PRLoma)的临床特点及妊娠结局。方法回顾性分析2013年1月至2023年12月首都医科大学宣武医院收治的53例妊娠合并PRLoma患者的临床资料。根据肿瘤最大径分为微腺瘤组(<1 cm,n=46)和大腺瘤组(≥1 cm,n=7)。分析2组患者的妊娠合并症和母儿结局,以及孕期首次诊断PRLoma者的临床特点。采用独立样本t检验或χ^(2)检验(或Fisher精确概率法)进行统计学分析。结果(1)53例患者年龄(31.9±7.1)岁,初产妇50例(94.3%);孕前诊断PRLoma 48例(90.6%),孕期诊断5例(9.4%)。53例的妊娠合并症包括甲状腺功能减退(14例,26.4%)、妊娠期高血糖(11例,20.7%)、妊娠期高血压疾病(7例,13.2%)、垂体卒中(6例,11.3%)和产后出血(4例,7.5%)。1例(1.9%)发生胎儿生长受限。(2)53例中的4例(7.5%)发生早期妊娠丢失(均<孕10周),49例(92.5%)妊娠至分娩,其中阴道分娩18例(36.7%),剖宫产31例(63.3%)。大腺瘤组≤34周早产率高于微腺瘤组[2/7与2.2%(1/46),χ^(2)=7.93,P=0.005],分娩孕周小于微腺瘤组[(36±2)周与(38±6)周,t=3.03,P=0.003]。(3)产后随访到的39例中,3例(7.7%)因持续口服溴隐亭治疗,采用人工喂养;其余36例(92.3%)均母乳喂养,持续时间12(1~24)个月;13例(33.3%)产后复查MRI显示垂体瘤消失,其余26例(66.7%)未复查影像学检查。(4)孕期诊断的5例患者肿瘤直径均>2 cm,其中1例孕19周行手术治疗后视力恢复,继续妊娠至足月分娩;4例产后手术治疗,视野缺损均改善。结论妊娠合并PRLoma者中,孕期诊断者肿瘤直径均>2 cm。妊娠合并PRLoma应根据肿瘤大小个体化处理,加强孕期监测,适时干预可获得良好妊娠结局。微腺瘤患者妊娠结局优于大腺瘤患者。
Objective To investigate the clinical features and pregnancy outcomes of prolactin-secreting adenomas(PRLomas)complicating pregnancy.MethodsThis retrospective study analyzed 53 pregnant women with PRLomas treated at Xuanwu Hospital,Capital Medical University between January 2013 and December 2023.Patients were stratified into microadenoma(<1 cm,n=46)and macroadenoma(≥1 cm,n=7)groups based on tumor size.Maternal complications,perinatal outcomes,and clinical characteristics of PRLomas diagnosed during pregnancy were evaluated.Statistical analysis was performed using independent samples t-test or Chi-square(or Fisher's exact)test.Results(1)Among the 53 patients(mean age 31.9±7.1 years),50(94.3%)were primiparas and 48(90.6%)were diagnosed before pregnancy,five(9.4%)during pregnancy.Maternal complications included hypothyroidism(14/53,26.4%),gestational hyperglycemia(11/53,20.7%),hypertensive disorders of pregnancy(7/53,13.2%),pituitary apoplexy(6/53,11.3%),postpartum hemorrhage(4/53,7.5%),and fetal growth restriction(1/53,1.9%).(2)Early pregnancy loss occurred in 7.5%(4/53)(<10 weeks'gestation),while 49 cases(92.5%)completed their pregnancies and delivered,including 18 vaginal deliveries(36.7%)and 31 cesarean deliveries(63.3%).The macroadenoma group had a higher preterm birth rate≤34 weeks[2/7 vs.2.2%(1/46),χ^(2)=7.93,P=0.005]and shorter gestational age at delivery[(36±2)weeks vs.(38±6)weeks,t=3.03,P=0.003]compared to the microadenoma group.(3)Postpartum follow-up of 39 cases revealed 7.7%(3/39)required artificial feeding due to bromocriptine therapy,while 92.3%(36/39)breastfed for 12(1-24)months.Postpartum MRI showed tumor resolution in 33.3%(13/39),though 66.7%(26/39)lacked imaging follow-up.(4)All five pregnancy-diagnosed PRLomas were>2 cm.One patient underwent surgical resection at 19 weeks with restored vision and term delivery,while four received postpartum surgery with improved visual deficits.ConclusionsPatients with pregnancy-associated PRLoma diagnosed during pregnancy all had tumors>2 cm in diameter.Management should be individualized based on tumor size,with intensified pregnancy monitoring and timely intervention to achieve favorable outcomes.Microadenoma cases demonstrated better pregnancy outcomes than macroadenoma cases.
作者
杨华威
张心红
Yang Huawei;Zhang Xinhong(Department of Obstetrics and Gynecology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)
出处
《中华围产医学杂志》
北大核心
2025年第6期504-508,共5页
Chinese Journal of Perinatal Medicine
