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

Diagnosis and transsphenoidal microsurgery of pituitary abscess

Objective: To discuss the diagnosis and transsephenoid microsurgery of pituitary abscess. Method:Seven patients with pituitary abscesses were proved by transsphenoidal microsurgery,though four of them were diagnosed as pituitary neoplasm preoperatively. 5 patients were male,2 female. The average age is 38 8 year old. Duration of symptoms were 2 3 years in average. Preoperatively,diabetes insipidus was present in 5 patients,hypopituitarism in 4,headache in 3,visual interference in 2,and oculomotor nerve palsy in 1.Pituitary abscess were removed and drainaged completely by transsphenoid microsurgery. Results:After operation pituitary abscess of all paitents were confirmed to disappeared by MRI.Headache in 2 patients and visual interference in 2 patients were resoluted. Polyuria in 3 of 5 patients and hypopituitarism in 2 of 4 patients were improved after operation. Conclusion:Pituitary abscess should be considered when patients presented diabetes insipidus,hypopituitarism,sella bone erosion and sella neoplasm similar to a cyst tumor in CT or MRI. Transsphenoid microsurgery to drainage abscess with use of antibiotic is the key of treatment for pituitary abscess.