垂体Rathke囊肿的诊断和手术治疗

目的分析和讨论垂体Rathke囊肿的诊断和手术治疗。方法回顾分析41例经手术和病理证实的垂体Rathke囊肿的病例,男性16例,女性25例,平均年龄32.8岁,平均病程为20.6月。主要临床表现包括头痛(62.5%)、垂体功能紊乱(55%)、视功能障碍(32%)等。CT及MR检查发现鞍区囊性肿物。39例采用经口鼻蝶窦入路显微外科手术,2例采用开颅手术,切除部分囊壁,敞开囊腔,清除囊肿内容物。结果术前正确诊断为垂体Rathke囊肿的仅为7例,术后随诊3月至8年,头痛病人的症状全部缓解,垂体功能紊乱病人55%得到改善,视功能障碍病人75%得到改善。41例病人术后均无复发。结论垂体Rathke囊肿术前较难明确诊断,MR检查信号呈多样性,无特异性。经口鼻蝶窦入路显微外科手术可以明确诊断,缓解症状,患者预后良好,是治疗垂体Rathke囊肿的有效方法。

Diagnosis and treatment of microsurgery of Rathke'' s cleft cysts

Objective To analyze the diagnosis and surgical treatment of Rathke's cleft cysts. Methods A retrospective analysis was conducted over the clinical data of 41 pathologically-diagnosed Rathke's cleft cysts treated by microsurgery, with16 male and 25 female, average age of 32.8 and average diseased course of 20.6 months. The typical clinical manifestations included headache (62.5%), pituitary dysfunction (55%) and visual interference (32%). Computed tomography and magnetic resonance imaging showed cystic mass in the area of sella turcica. 39 cases were treated by transsphenoidal microsurgery and 2 were treated through craniotomy, with the cyst wall partially removed and the contents in it drained out. Results Before operation, only 7 cases were correctly diagnosed. In 3 months to 8 years of follow-up, symptom of headache were all resolved, pituitary dysfunction were resolved in 55% and visual interference in 75%. No patients were found to have recurrence. Conclusion It is difficult to establish the correct diagnosis of Rathke's cleft cysts before operation. The magnetic resonance imaging signals were varied and nonspecific. Transsphenoidal microsurgery can verify the diagnosis and resolve the symptoms, which is the effective way to treat the Rathke's cleft cysts.