Rathke裂囊肿的诊断和治疗VIP免费

[文章编号]1005�1139(2004)01�0012�03Rathke裂囊肿的诊断和治疗魏少波,周定标,潘隆盛,朱儒远(解放军总医院神经外科,北京�100853)��[摘要]�目的:提高Rathke裂囊肿的诊断和治疗水平。方法:回顾性研究1993年到2002年,在我院经蝶手术的33例Rathke裂囊肿,术前头痛占78�8%,垂体功能紊乱占62�4%,视力减退27�3%。X线平片蝶鞍扩大者占15�2%,CT呈高密度者占61�5%,MRIT1像显示63�6%的囊肿呈高信号,15�2%等信号,12�1%低信号,9�1%混合信号,囊肿均不被强化。33例均经蝶入路手术切除病变。结果:术后100%患者的视力改善,84�6%头痛消失或减轻,72�7%月经恢复,66�7%乏力感消失,50%体重明显减轻。结论:Rathke裂囊肿垂体功能紊乱发生率比人们估计为高;如发现鞍内一囊性结构,CT显示为高密度,MRIT1像表现为高或低信号,强化后无增强,应考虑为Rathke裂囊肿;绝大多数Rathke裂囊肿可经鼻蝶入路清除病灶,并能有效地改善临床症状及垂体功能;积极手术治疗,即使是病人有轻微的症状和体征,以免发生不可逆转的垂体功能低下。[关键词]垂体疾病;Rathke裂囊肿;神经外科手术[中图分类号]R651�1���[文献标识码]ADiagnosisandtreatmentofRathke�scleftcystsWEIShao�b0,ZHOUDing�biao,PanLong�sheng,ZHURu�yuan(DepartmentofNeurosurgery,PLAGeneralHos�pital,Beijing100853,China)[Abstract]�Objective:ToraisethediagnosandtreatmentlevelofRathke�scleftcysts�Methods:WeretrospectivelyrevieweddatacollectedonRathke�scleftcystsbetween1993and2002,33patientspresentingsymptomsweretreatedbytranssphenoidalsurgery�Be�foretheoperation,headachewaspresentin78�8%,pituitarydysfunctionin62�4%andvisualinterferencein27�3%,enlargementofthesellaturcicaonplainx�raysin15�2%�CTshowedhighdensitylesionin61�5%,andMRIshowedhighintensityonT1weightedim�ageslesionin63�6%,iso�intensityin15�2%,lowintensityin12�1%,andothersin9�1%andnoenhancementinallofcases�Allpa�tientsweretreatedbyatranssphenoidalsurgery�Results:Postoperativevisualdisturbanceimprovedin100%ofpatients,headacheswereresolvedin84�6%,Amenorrhearecoveredorimprovedin72�7%�Conclusions:Resultsofthepresentstudyindicate:1)TheincidenceofpituitarydysfunctioninpatientswithRathke�scleftcystishigherthansuspected�2)�Whenanon�enhancingcyst�likestructureinthesellaturcicawithCTshowedhighdensityandMRIshowedhighintensityorlowintensityonT1isdemonstrated,thepossibilityofRathke�scleftcystshouldbeconsidered�3)�MostRathkecleftcystscanbetreatedbyatranssphenoidalsurgeryandinmostcasessurgicalinter�ventionimprovespituitaryfunctionandtheclinicalstatusofthepatient�4)�Surgicaltreatmentisrecommendedevenwhenthepatienthasonlymildsymptomsorsigns,includingpituitarydysfunction,topreventirreversiblepanhypopituitarism�[Keywords]pituitarydiseases;Rathke�scleftcyst;neurosurgicalprocedures��尽管Rathke裂囊肿在常人中发现率不少见[1],但出现临床表现者为数不多。由于其不生长或生长缓慢,临床症状和影像学的多样性,许多病例被误诊。我们自1993年5月至2002年5月共手术33例Rathke裂囊肿,效果良好。[收稿日期]2003�07�31���[修回日期]2003�08�21[作者简介]魏少波(1953�),男,山东济南人,1990年军医进修学院硕士毕业,副主任医师,发表论文20余篇。电话:(010)669373351�临床资料1�1�一般资料�男12例,女21例,年龄16~76岁,平均28�5岁。病程7d~13年,平均3�2年。1�2�临床表现�头痛26例,闭经或月经紊乱11例,视力障碍9例,肥胖8例,全身乏力6例,性欲低下4例,尿崩、复视、高血糖、高血压各2例,生长迟缓、双眼多泪各1例,因头部外伤或查体偶然发现5例。1�3�激素检查�24例检查血PRL,16例超过正常值,为21~54�g/L,平均26�6�g/L。皮质醇水平和�12��军医进修学院学报�AcadJPLAPostgradMedSch�2004Feb,25(1)甲状腺水平低下各...