摘要
目的 提高对囊性垂体瘤（PA）、颅咽管瘤（CR）、蛛网膜囊肿（AC）和拉克氏囊肿（RCC）鞍内囊性占位病变的治疗方法和预后的认识.方法 对72例鞍内囊性病人采取了经鼻蝶入路手术治疗.比较术前的临床表现,生化检查结果和神经影像特点及差异,给出初步诊断;术中进一步验证诊断,术中所见结合术前特点,选择不同手术策略;术后随访,观察临床症状变化,根据病理性质分组,观察病变复发情况.随访12～52个月,平均34个月.72例病变中：囊性PA 32例（44.4%）,RCC 27例（37.5%）,CR 10例（13.9%）,AC 1例（1.4%）.内分泌症状中CR有较明显的全垂体功能低下（8例,80%）,PA（15例,55.6%）和RCC（12例,44.4%）中反馈性泌乳素轻度增高较其他病变多.结果 （1）影像学特点：囊性PA囊壁强化明显,强化部分为肿瘤成分;CR出现钙化的概率高（70%）;典型的RCC位于垂体前叶和后叶之间,囊液信号多样;AC囊液同脑脊液信号,垂体被推挤向 后方.（2）术后：术后占位征象均消失,CR需要长期的激素替代治疗（6例CR）.其他几种疾病内分泌可在1～2个月内恢复正常.尿崩症出现的比例CR 9例（90%）,RCC 11例（40.7%）高于其他两种疾病.（3）复发：PA复发1例,CR复发2例,RCC和AC没有复发.结论 应了解各种鞍内囊性病变特点,诊断明确,采取不同的治疗策略,改善疾病预后.
Objective To make a clear distinction of intrasellar cystic lesions： craniopharyngioma （CR）, Rathke＇s cleft cyst（RCC）, cystic pituitary adenoma（PA）and intrasellar arachnoid cyst（AC）.Methods A total of 72 adult patients underwent transsphenoidal approach for the removal of intrasellar cystic lesions. The authors conducted a study to（1）investigate preoperative clinical, biochemical and radiographic features of patients with CR, RCC, PA and AC;（2）identify clinicopathological features of independently predicting recurrence in CR, PA and RCC in adults. These adult patients included CR（n =10）, RCC（n = 27）, cystic PA（n=32）and 1 patient with AC（n = 1）. Results The CR patients presented with hypopituitarism in 80% of cases. According to the biochemical criteria, the percentage of patients with a slight prolactin increase happened in PA（55.6%）and RCC（44. 4%）. Cystic PA had postcontrasting enhancement in cyst wall because of rumor tissue. Calcification detectable on computed tomographic scanning was present in 70% of CR patients. It was a significantly greater proportion compared to other diseases. Typical RCC was located between anterior and posterior pituitary and the contents in RCC were variable. Mass effects vanished post-operatively in all kinds of lesions. Long-term hormone replacement therapy was administered more in CR patients（60%）and diabetes insipidus than other lesions. One PA patient and 2 CR patients had recurrence during a follow-up of 12-52 months（mean： 34）. RCC and AC had no recurrence. Conclusion Craniopharyngioma, Rathke＇s cleft cyst, cystic pituitary adenoma and intrasellar arachnoid cyst are a spectrum of diseases with different therapeutic strategies. An accurate diagnosis of these lesions is essential so as to determine the type of treatment to improve outcome.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2010年第41期2932-2934,共3页
National Medical Journal of China
关键词
颅咽管瘤
垂体腺瘤
拉克氏囊肿
蛛网膜囊肿
Craniopharyngioma
Rathke＇s cleft cyst
Pituitary adenoma
Arachnoid cyst
