垂体腺瘤合并Rathke囊肿27例并文献复习

目的分析垂体腺瘤合并Rathke囊肿的临床特征与治疗方法。 方法回顾性分析自2010年1月至2018年12月在哈尔滨医科大学附属第一医院神经外科二病房收治的27例行经鼻蝶窦入路手术切除垂体腺瘤合并Rathke囊肿患者的临床资料。所有患者均在术前、术后行垂体MRI检查及内分泌检查。由经验丰富的病理学专家对取出的标本作出病理诊断，以确保功能型垂体腺瘤的精确分类。观察患者术后的病情变化并且记录术后第1天和第7天的内分泌结果。结合27例垂体腺瘤合并Rathke囊肿的临床资料并结合相关文献进行分析。 结果垂体腺瘤合并Rathke囊肿的临床症状与垂体腺瘤类似；MRI在垂体区均发现两种质地不同的信号（一侧为实质性病变，一侧为囊性病变），这两种信号之间有或无明显的间隔，且增强可见实性病变增强而囊性病变未增强；27例患者病变全切，术中可见实质性肿瘤和半流质Rathke囊肿内容物；随访期间，1例合并泌乳素型的垂体腺瘤患者复发，泌乳素增高，其余患者均未复发，且激素水平均恢复正常。 结论垂体腺瘤合并Rathke囊肿罕见，症状与垂体腺瘤相似，确诊依赖于病理。MRI垂体区囊性和实性病变共存，应考虑垂体瘤合并Rathke囊肿可能，经蝶窦入路切除术可有效治疗该病。

Pituitary adenoma complicated with Rathke cyst: 27 cases report and literature review

ObjectiveTo analyze the clinical features and treatment of pituitary adenoma complicated with Rathke cyst. MethodsThe clinical data of 27 patients with pituitary adenoma complicated with Rathke cyst who underwent transsphenoidal sinus resection were retrospectively analyzed in the Second Ward of Neurosurgery Department of the First Affiliated Hospital of Harbin Medical University from January 2010 to December 2018. All patients underwent MRI examination and endocrine examination before and after surgery. Extracted specimens are pathologically diagnosed by an experienced pathologist to ensure accurate classification of functional pituitary adenomas. The changes of patients’ condition after operation were observed and the endocrine results on the first and seventh day were recorded. The clinical data of 27 cases of pituitary adenoma complicated with Rathke cyst were analyzed in combination with relevant literature. ResultsThe clinical symptoms of pituitary adenoma with Rathke cyst were similar to those of pituitary adenoma. MRI showed two different signals (solid lesion on one side and cystic lesion on the other side) in the pituitary region, with or without significant interval between the two signals, and enhanced solid lesions but not cystic lesions were observed. Total resection was performed in 27 patients, and solid tumor and semicfluid Rathke cyst contents were observed intraoperatively. During the follow-up, one pituitary adenoma with prolactin type recurred with increased prolactin, while the other patients did not relapse and their hormone levels returned to normal. ConclusionPituitary adenoma with Rathke cyst is rare and the symptoms are similar to pituitary adenoma. The diagnosis depends on pathology. MRI pituitary cystic and solid lesions coexist, pituitary tumors with Rathke cyst should be considered. Transsphenoidal sinus resection is an effective treatment for this disease.