目前的指南推荐多巴胺激动剂（DA）作为泌乳素瘤的主要治疗方法；然而，新的证据表明手术干预也可以产生良好的结果。为了全面评估在我们垂体中心接受手术和药物治疗的泌乳素瘤患者。对 2015 年至 2022 年期间治疗的泌乳素瘤患者的医疗记录进行了回顾性审查。该研究重点关注治疗结果和缓解率，同时调查影响两种治疗方式成功实现缓解的因素。总共纳入了 301 名泌乳素瘤患者，其中 199 名是女性。其中，235人接受药物治疗，66人接受手术治疗。最终检查时，药物治疗和手术治疗的患者总体缓解率相似（分别为82.9%和81.8%，p=0.114）。两种治疗方式中与缓解相关的因素包括女性、初始催乳素水平低、腺瘤尺寸小以及没有海绵体浸润。与 DA 治疗相比，对于微腺瘤和无海绵体浸润的大腺瘤，手术治疗显示出更高的无药物缓解率。对于海绵状血管侵犯的病例，单独的手术治疗无药物缓解率较低（7.7%）；然而，当与术后联合 DA 治疗时，缓解率增加至 66.7%。 DA 治疗仍然是侵犯海绵窦的大腺瘤和巨大腺瘤的首选，只有特定病例才需要手术治疗以解决并发症。相反，手术成为微腺瘤和局限于鞍区的大腺瘤患者实现缓解的最有效方法。目前的指南已取消将 DA 作为所有患者一线治疗的建议，并强调基于肿瘤特征的个体化治疗方法。我们的结果支持这种方法。Thieme。版权所有。

Current guidelines recommend dopamine agonists (DA) as the primary therapeutic approach for prolactinomas; however, emerging evidence suggests that surgical intervention can also yield favorable outcomes.To comprehensively evaluate prolactinoma patients undergoing surgical and medical treatments at our pituitary center.Retrospective review of medical records from prolactinoma patients treated between 2015 and 2022 was performed. The study focused on treatment outcomes and remission rates while investigating factors influencing the success of both treatment modalities in achieving remission.A total of 301 prolactinoma patients were included, of whom 199 were women. Among them, 235 were managed medically, while 66 underwent surgical intervention. The overall remission rates of patients treated with medical and surgery were similar at the final examination (Respectively 82.9% and 81.8%, p=0.114). Factors associated with remission in both treatment modalities included female sex, low initial prolactin levels, small adenoma size, and absence of cavernous invasion. Surgical treatment demonstrated a higher rate of drug-free remission compared to DA treatment for microadenomas, and macroadenomas without cavernous invasion. In cases with cavernous invasion, standalone surgical treatment yielded a low rate of drug-free remission (7.7%); however, when combined with DA therapy post-surgery, remission rates increased to 66.7%.Medical treatment with DAs remains the preferred option for macroadenomas with cavernous sinus invasion, and giant adenomas, with surgery reserved for selected cases to address complications. Conversely, surgery emerges as the most effective modality for achieving remission in patients with microadenomas, and macroadenomas confined to the sella. The recommendation of DAs as first-line therapy for all patients has been withdrawn in the current guidelines and individual treatment approaches based on tumor characteristics are emphasized. Our results support this approach.Thieme. All rights reserved.