垂体Rathke囊肿的诊断和经蝶窦手术治疗

目的分析和探讨垂体Ｒａｔｈｋｅ囊肿的诊断和治疗。方法２２例经手术和病理证实为垂体Ｒａｔｈｋｅ囊肿的病例，男性８例，女性１４例。平均年龄３４．６岁。平均病程２３．５月。临床症状依次为头痛，垂体功能障碍，视功能障碍等。ＣＴ及ＭＲＩ检查表现鞍区囊性肿物。均采用经口鼻蝶窦显微手术清除囊肿内容物，切除少量囊壁，敞开囊腔。结果随诊半年至５．６年，７５％的头痛症状、７１％的视功能障碍、５０％的停经溢乳症状缓解。结论垂体Ｒａｔｈｋｅ囊肿术前较难明确诊断，对于影像学检查为鞍区囊性肿物者要考虑垂体Ｒａｔｈｋｅ囊肿。经口鼻蝶窦显微外科手术可以明确诊断，缓解症状，是治疗有症状性垂体Ｒａｔｈｋｅ囊肿的有效方法。

Diagnosis and transsphenoidal microsurgery of Rathke's cleft cysts

Objective To discuss the diagnosis and transsphenoidal surgery of Rathke's cleft cysts.Methods From Oct. 1991 to Dec. 1996, 22 patients were treated by transsphenoidal surgery. 8 patients weremale, 14 female. Mean age were 34.6 years old. Duration of symptoms were 23.5 months in average ranged from 1month to 5 years. Before the operation, headache was present in 54.5%, pituitary dysfunction in 50% and visual interference in 31.8%. Computed tomography and magnetic resibabce imaging showed cystoid lesion like cyst masswith capsular in contrast enhancement in some cases. 22 patients were treated with drainage of content, biopsy of cystwall and cyst opening. Results In follow-up period from half a year to 5.6 years. headaches were resolved in 75%,visual interference in 71% and amenorrhea-galactorrhea syndrome in 50%. Conclusions It is difficult ti establishthe diagnosis by the clinic symptoms and radiological findings. Transsphenoidal surgery is an effective treatment toprove the diagnosis and to resolve the symptoms.