垂体脓肿的诊断与治疗（附9例临床分析）

目的探讨垂体脓肿的临床特点和治疗方法。方法回顾性分析9例垂体脓肿患者的临床表现、影像学特征、诊断和治疗,并结合文献进行分析。结果9例患者中有8例经鼻蝶入路手术,1例行大脑开颅手术。视功能改善77.8%（7/9）,头痛缓解83.3%（5/6）,垂体功能低下改善25%（1/4）,尿崩症缓解33.3%（1/3）。结论垂体脓肿的发生有增多趋势;当患者头痛、视力视野障碍、垂体功能低下,尤其有尿崩的出现,结合影像学检查,鞍区磁共振及增强示类圆形囊状占位性病变,等或长T1,长T2,囊壁呈环形强化（＂鸭梨＂征）等,应考虑垂体脓肿的诊断。诊断一旦确定,应尽早行手术治疗,入路以经蝶为首选;术后予抗感染、补充激素及对症等治疗。     

垂体脓肿的诊断和经蝶显微手术治疗

目的探讨垂体脓肿的诊断及治疗方法。方法回顾性分析我院15例垂体脓肿患者的临床表现、影像学特征、诊断和治疗。结果15例患者中术前主要表现为头痛8例,视力下降或颞侧偏盲6例,垂体前叶功能低下7例,尿崩4例,发热1例。MRI增强示病灶均呈环形强化。15例患者均采用经鼻蝶手术入路清除脓肿。术后1W,8例头痛患者症状均消失,6例视力下降患者中4例改善;术后随访至第3个月,4例尿崩患者有2例恢复正常,7例垂体功能减退患者中4例好转,另3例患者继续予以药物替代治疗;术后6个月,另2例仍多饮多尿患者和3例垂体功能仍低下者均恢复正常。15例患者均无复发。结论垂体脓肿术前诊断较困难,对鞍区囊性病变应考虑到垂体脓肿的可能性。及早采用微创手术、合理应用抗生素及恰当的对症治疗是治疗垂体脓肿的关键。     

垂体脓肿的诊断和经蝶窦显微手术治疗

目的：探讨垂体脓肿的诊断和经蝶窦显微手术治疗。方法：经蝶窦显微手术证实为垂体脓肿７例，３例术前诊断为垂体脓肿，４例诊断为其它鞍区病变。男性５例，女性２例，平均年龄３８．８岁，平均病程２．３年。临床症状尿崩症５例，垂体功能低下４例，头痛３例，视力视野障碍２例，动眼神经麻痹１例。手术中彻底清除脓肿，放置碘仿纱条引流。结果：随诊３个月～６年，影像学检查脓肿征象均消失。３例头痛、２例视神经功能障碍术后缓解；３例尿崩症、２例垂体功能低下改善，１例术后２年复发。结论：若鞍区病变不大，但引起较严重的蝶鞍骨质破坏，表现为尿崩症和垂体功能低下时，应首先考虑垂体脓肿。及时手术探查，彻底清除脓肿和术后使用抗生素是治疗垂体脓肿的关键     

垂体脓肿的诊治分析:附3例报告并文献复习

目的 探讨垂体脓肿的临床表现和治疗方法。方法 回顾性分析手术治疗的3例垂体脓肿患者的临床资料,并结合相关文献进行分析。结果 术后随访3个月~1年,3例患者头痛及垂体功能低下明显好转,逐渐停用激素替代;1例有尿崩患者尿量明显减少。结论 患者有前驱发热及头痛病史,有垂体功能低下、尿崩的临床表现及垂体MRI、鞍区CT影像学特征,应高度怀疑垂体脓肿;及时、规范的治疗可达到良好的效果。     

垂体脓肿8例临床分析

目的探讨垂体脓肿的临床特征和治疗.方法回顾性分析8例垂体脓肿患者的临床表现、影像学特征、诊断和治疗,并结合文献进行分析.结果8例患者中仅1例有明显颅内感染征象,视力视野障碍者5例,尿崩者4例,垂体功能低下者4例,影像学常无特征性改变.4例经开颅手术,4例经蝶手术治疗.术后随访5例患者中4例脓肿无复发,视力视野改善者2例,尿崩者2例恢复正常,垂体功能低下者随访2例患者中1例恢复正常,1例经翼点入路手术者脓肿复发.结论垂体脓肿术前诊断困难,对鞍区囊性病变应考虑到垂体脓肿的可能,及早手术、正确地选择手术入路、合理应用抗生素和适当的对症治疗是治疗垂体脓肿的关键.     

鞍区黄色肉芽肿病例分析并文献复习

目的探讨鞍区黄色肉芽肿的诊断、治疗及预后。方法回顾性分析1例鞍区黄色肉芽肿病例的临床资料,病人术前头痛,右眼视力0.8,内分泌检查提示甲状腺功能低下,其他未见异常。显微镜下肿瘤全切。结合文献分析该病的临床表现、病理、影像学特点及治疗措施。结果病人术后头痛症状消失,视力好转,垂体功能低下无改善,并发尿崩症。3个月后复查未见肿瘤复发,但垂体功能低下及尿崩症仍未消失,需要长期激素替代治疗。结论鞍区黄色肉芽肿是一种罕见的颅内良性肿瘤,术前诊断困难,手术是首选治疗方式,复发少见,但常并发垂体功能低下。     

鞍区囊性病变的鉴别诊断对手术入路的参考意义

目的 分析和比较颅咽管瘤、囊性垂体腺瘤、Rathke囊肿及垂体脓肿等四种鞍区囊性病变的临床特征,建立鞍区囊性病变的诊断流程.方法 运用统计学方法分析93例鞍区囊性病变患者的临床资料,比较不同患者临床特征的差异.结果 发病年龄较小、病变体积较大、第三脑室压迫、实性部分网状强化常见于颅咽管瘤;海绵窦侵犯、实性部分均匀强化常见于囊性腺瘤;Rathkc囊肿和垂体脓肿多表现为单纯囊性;病程短、尿崩、≥2个腺垂体激素低下及病变环形强化多见于垂体脓肿.结论 鞍区囊性病变的临床特征互相重叠,但又有一定的特异性;综合分析,有助于这四种囊性病变的鉴别.     

垂体脓肿的诊断和治疗(附2例报告及文献复习)

目的探讨垂体脓肿的临床、影像学特点及治疗,提高对垂体脓肿的认识和诊治水平。方法回顾性分析2例垂体脓肿患者的临床表现、影像学特征、诊断和治疗经过,并结合相关文献分析垂体脓肿的诊断和鉴别诊断。结果 2例中年女性患者,主要临床症状为头痛、发热、视觉障碍、多饮多尿、闭经和全身乏力。MRI增强扫描示垂体病灶环形强化伴垂体柄明显强化。例1患者经额下入路清除脓肿,术后使用抗生素和对症治疗,恢复良好。例2患者经鼻蝶入路清除脓肿,术后2个月复发,再次经鼻蝶入路清除脓肿,术后恢复良好。结论垂体脓肿术前诊断困难,早期出现视力和视野改变、尿崩,以及影像学检查出现鞍区环形强化的囊性病灶应考虑垂体脓肿的可能性。早诊断、围手术期合理应用抗生素、及时手术和适当的对症治疗是治疗的关键。     

垂体脓肿的诊断和治疗(14例报告和文献复习)

目的:探讨垂体脓肿的临床特征和治疗。方法:回顾性分析14例垂体脓肿患者的临床表现、影像学特征、诊断和治疗,并结合文献进行分析。结果:14例患者中头痛13例,垂体功能低下6例,视力视野影响6例,多饮多尿3例,发热3例。MRI增强病灶均呈环状强化。11例经蝶手术治疗,3例经开颅手术。术后随访头痛缓解者10例,视力、视野改善者4例,尿崩者2例恢复正常,垂体功能低下者中4例恢复正常,3例开颅手术者中2例复发,再经蝶手术治愈。结论:应用常规CT和MR术前诊断垂体脓肿困难,对鞍区囊性病变应考虑到垂体脓肿的可能。及早手术、正确选择手术入路、围手术期合理应用抗生素和适当的对症治疗是治疗垂体脓肿的关键。     

垂体转移癌的临床诊治

目的 总结垂体转移癌临床诊断和治疗的相关问题。方法 回顾分析3例住院手术治疗的垂体转移癌病人的临床资料。结果 病人均以尿崩、眼肌麻痹、头痛为首发症状．激素水平正常，影像学表现为鞍区不规则浸润性肿瘤．病理学诊断均为垂体转移性腺癌．2例来源于肺癌转移，1例来源丁结肠癌转移，手术后平均生存135d。结论 垂体转移癌病人影像学检查多难以确诊，预后极差。     

垂体脓肿的诊断与治疗

目的 探讨垂体脓肿的临床特点、诊断和治疗.方法 回顾性分析15例垂体脓肿患者的临床表现、影像学特征、诊断和治疗.结果 15例垂体脓肿术前误诊13例,9例经鼻蝶窦入路,2例经额下入路后改为经鼻蝶窦入路,4例行额下入路.15例患者术后均恢复良好,随诊未见复发.结论 早期出现视力和视野改变、尿崩和环形强化的鞍区囊性病灶应首先怀疑垂体脓肿,早诊断,合理应用抗生素,正确选择手术入路,及时手术治疗是改善预后的关键.     

垂体脓肿(附五例报告及文献复习)

目的 探讨垂体脓肿的临床特点、早期诊断和治疗选择。方法 5例垂体脓肿均行手术治疗，3例经额下入路，2例经蝶入路。本文逐一分析了对5例垂体脓肿的诊疗经验。结果 男性3例，女性2例，年龄在12～56岁，主要症状为感染史，头痛，视力减退，多饮多尿和垂体功能低下等。神经影像学表现为：强化的T1加权像可见鞍内／鞍上低密度肿物，周围有强化环。5例患者术后均恢复良好，随诊未见复发。结论 垂体脓肿早期明确诊断后，最佳选择为经蝶手术治疗。     

CT and MRI findings in primitive pituitary abscess: a case report and review of literature

Pituitary abscess is not rare. Clinical and radiological features in a primitive pituitary abscess are reported. Transphenoidal surgery revealed an abscess. Preoperative diagnosis of pituitary abscess remains difficult. Sellar round cystic mass isointense to grey matter on T1, high intensity signal on T2, with a peripheral rim enhancement following gadolinium injection associated with thickened stalk and diabetes insipidus may be suggestive of pituitary abscess.     

Colloid cysts of the pituitary gland

Colloid cysts of the pituitary gland are very rare pathological lesions occurring in sellar region. Their pathogenesis is not clear. They are located between the anterior and posterior lobe of the pituitary. Colloid cysts of the pituitary gland are space occupying lesions and induce hypopituitarism, diabetes insipidus, visual disturbances, etc. They cause pituitary apoplexy too. Magnetic resonance imaging is the preferred neurodiagnostic method in evaluating these lesions. 503 transsphenoidal procedures were performed from January 1996 to February 2001. Hypothalamo-hypophyseal dysfunction was caused by colloid cyst in seven cases. The most frequent presenting symptoms were headaches, oligomenorrhea and loss of libido. Diabetes insipidus was found in two cases before surgery. Colloid cyst induced pituitary apoplexy in one patient. Two patients presented visual disturbances. All our patients were operated on. We performed six transsphenoidal procedures and one transcranial operation. Postoperatively, the endocrine function of the pituitary gland was evaluated. We concluded that transsphenoidal operation is a safe method for treating colloid cyst located in the sellar region.     

垂体脓肿的临床特征和经蝶窦手术治疗

目的 分析垂体脓肿的临床特征和经蝶窦手术治疗。方法 12例垂体脓肿的术前症状依次为尿崩症、头痛、垂体功能低下和视功能障碍。MRI显示垂体类圆形肿物。均经蝶窦入路显微外科手术清除脓肿，反复冲洗和放置引流。结果 随诊1～10年。头痛缓解为71％(5／7)，视功能改善80％(4／5)，尿崩症缓解63％(5／8)，垂体功能低下改善50％(3／6)。结论 当MRI显示垂体肿物的病人出现严重的尿崩症和垂体功能低下时，应考虑到垂体脓肿。怀疑为垂体脓肿者应及时经蝶窦术清除脓肿和引流。     

A cse of Rathke''s cleft cyst presenting with diabetes insipidus

Rathke's cleft cysts (RCCs) are considered to arise from the remnants of Rathke's pouch, an invagination of the stomodeum. They classically described as benign epithelium lined intrasellar cysts containing mucoid material, and also found in 2–33% of routine autopsy series. The most common presenting symptoms are visual impairment, hypothalamic dysfunction, hypopituitarism and headache. Diabetes insipidus has been described in patients with RCC. Very few cases presented with only diabetes insipidus in adults. To our knowledge, our patient is the first case of RCC presenting with only diabetes insipidus in childhood. A 9-year-old girl presented with diabetes insipidus. The physical, neurological and endocrinological examinations were normal, except for diabetes insipidus. Magnetic resonance imaging scan revealed a hyperintense lesion with supra sellar extension in the posterior pituitary both on T1 and T2 weighted images. Subtotal excision of RCC was performed via transsphenoidal surgery. However, diabetes insipidus persisted after the surgery.