鞍内囊性病变治疗策略的临床观察  

Therapeutic strategy for intrasellar cystic lesions

作　　者：刘伟明[1] 倪明[1] 贾旺[1] 关树森[1] 贾桂军[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050

出　　处：《中华医学杂志》2010年第41期2932-2934,共3页National Medical Journal of China

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.

关 键 词：颅咽管瘤 垂体腺瘤 拉克氏囊肿 蛛网膜囊肿 

分 类 号：R686[医药卫生—骨科学]