蝶窦鞍区非垂体源性占位性病变的诊断  

The diagnosis of non pituitary space occupied lesions in sphenoidal sinus and sellar area

作　　者：徐春晓[1] 倪道凤[1] 张连山[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院耳鼻咽喉科

出　　处：《中华耳鼻咽喉科杂志》1998年第5期267-269,共3页Chinese Journal of Otorhinolaryngology

摘　　要：目的提高蝶窦鞍区非垂体源性占位性病变的诊断水平。方法总结分析２４例蝶窦鞍区非垂体源性占位性病变，其中良性１８例，包括蝶窦囊肿７例、颅咽管瘤６例、脊索瘤２例，鼻息肉伴鼻硬结杆菌感染侵犯蝶窦鞍区、蝶鞍神经鞘瘤、鞍内异位松果体瘤各１例。恶性肿瘤６例，分别为蝶窦神经内分泌肿瘤２例，腺样囊腺癌１例，蝶窦低分化癌１例，鼻咽癌侵犯鞍区及肺癌蝶窦转移各１例。从临床表现、体征、影像学检查及诊断治疗上进行了分析、讨论。结果２４例临床表现中１８例有头痛，１７例出现眼部症状。２４例均经ＣＴ扫描发现蝶鞍区占位性病变并提示了病变范围。结论①良恶性病变均以头痛为第一常见症状，眼部症状为第二常见症状，掌握眼部症状与蝶鞍占位的关系对及早诊断意义重大；②影像学检查对此区域病变的发现和诊断起着重要作用；③内窥镜的应用及镜下穿刺活检亦对诊断十分有帮助。良性肿瘤以手术切除为主，恶性肿瘤手术＋放射治疗。Objective To improve the diagnostic accuracy of non pituitary lesions in sphenoidal sinus and sellar area. Methods Twenty four cases with non pituitary lesions in sphenoidal sinus and sellar area were analyzed . Eighteen cases were benign, including 7 sphenoidal sinus cyst, 6 craniopharyngioma, 2 chordoma, 1 nasal polyp extending into the sella,1 neuronoma in sella,and 1 pinealoma. Six cases were malignant, including 2 malignant neuroendocrinoma in sphenoidal sinus, 1 adenoidocystic carcinoma, 1 sphenoidal sinus low differentiated carcinoma, 1 nasopharyngeal carcinoma extending into sella, 1 lung cancer metastasis to sphenoidal sinus. Clinical presentation, examination, imaging study, diagnosis and treatment were discussed. Results Among 24 cases, 18 had headache,17 had visual symptoms. In all cases the space occupied lesions in sphenoidal sinus and sellar area were rerified by CT scan.Conclusions ①Headache at different levels was the commonest symptom for benign and malignant lesions. The visual loss was another common symptom. It is important to realize the relationship between visual symptom and space occupied lessions in sphenoidal sinus and sellar area; ②Imaging study is very important for the diagnosis of the lesions in sphenoidal sinus and sellar area; ③It is helpful to do needle aspirating biopsy under endoscopy to confirm the pathologic diagnosis. The benign lesions were operatedon,and malignant lesions were treated by combined operation and radiation.

关 键 词：蝶鞍肿瘤 诊断 鼻窦肿瘤 囊肿 诊断 颅咽管瘤 

分 类 号：R739.620.4[医药卫生—肿瘤]