垂体Rathke囊肿的诊断和显微手术治疗

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个月。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MRI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，头痛患的症状全部缓解，垂体功能紊乱患55%得到改善，视功能障碍患75%得到改善，41例患术后均无复发。结论 垂体Rathke囊肿术前较难明确诊断，MRI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，患预后良好，是治疗垂体Rathke囊肿的有效方法。

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

Objective To discuss the diagnosis and surgical treatment of Rathkes cleft cysts. Methods Forty-one cases of Rathke 's cleft cysts verified by microsurgery and pathological results were retrospectively analyzed. Sixteen of them were male and 25 were female. The mean age was 32. 8 years. The duration of symptoms was 20.6 months in average. The main clinical manifestations included headache (62.5%) , pituitary dysfunctions (55%) and visual disturbance (32%). Computed tomography (CT) and magnetic resonance imaging (MRI) showed cystic mass in the area of sella turcica. Thirty-nine cases underwent microsurgical treatment by transsphenoid approach and 2 cases by craniotomy. In the operation, the contents of the cysts were removed or drained off, and the cyst walls were partially resected and kept open. Results Only 7 cases were correctly diagnosed prior to operation. Post-operative follow-up period ranged from 3 months to 8 years. Headache was completely relieved. Pituitary dysfunction was improved in 55% and visual disturbance in 75%. There was no recurrence. Conclusion It is difficult to establish the correct diagnosis of Rathke's cleft cysts before operation. The MRI signals often vary and show no specificity. Transsphenoidal microsurgery is an effective treatment for the Rathke's cleft cysts since it can relieve the symptoms and give a confirmed diagnosis.