拉克囊肿的手术治疗  

Operation Strategy for Rathke′s Cleft Cyst

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：《医学研究杂志》2010年第12期125-127,共3页Journal of Medical Research

摘　　要：目的随着诊疗水平的提高，拉克囊肿（Rathke’s cleft cyst，RCC）的发现逐渐增多，和垂体微腺瘤区别困难。由于治疗方法和预后与垂体腺瘤相比筹异明显，需要我们对这一疾病充分认识。方法对27例拉克囊肿病人采取了经鼻蝶人路手术治疗。记录术前的临床表现，生化检查结果和神经影像特点；记录术中所见；术后随访，观察临床症状变化，观察病变复发情况。结果27例病变均采用经蝶窦人路手术，头痛为主要表现（14例，52％），轻度泌乳素增高（14例，52％），两例患者同时存在头痛和泌乳素增高。全垂体功能低下（1例，3．7％）。影像学特点：典型的RcC位于腺垂体和神经垂体之间，囊液信号多样。手术处理：以囊液弓l流减压为主，可切除部分囊壁获取病理诊断。术后占位征象均消失，垂体功能可在1～2个月内恢复正常。尿崩症出现（11例，40．7％），均为短暂性。复发：随访12～52个月，平均34个月，没有复发。结论了解拉克囊肿的病变特点，术前诊断明确，采取相应的手术治疗策略，改善疾病预后。Objective The distinction between intrasellar cystic lesions - Rathke＇s cleft cyst （RCC） and cystic pituitary adenoma remains a difficult preoperative problem. Accurate diagnosis of these intrasellar lesions is important to determine the type of treatment and predict prognostic outcome. Methods 27 adult patients underwent transsphenoidal approach to remove RCC. We investigated the preop- erative clinical, biochemical, and radiographic features of patients and identified clinicopathological features that independently predicted recurrence. Results There were 27 RCC patients. The most syndrome was headache （ 14 cases, 52% ） , and then hypopituitarism （ 1 case, 3.7% ） and slightly prolactin increasing （14 cases, 52% ）. Typical RCC was located between anterior and posterior pituitary,and content in RCC was variation. As for operation, contents drainage was enough. Mass signs vanished in all lesions postoperation. Diabetes insipidus incidence rate was re｜ative high （ 11 cases, 40.7% ）. Fortunately, all cases recovered within 3 months. No patient recurred dur- ing follow up （ 12 ~ 52m, mean 34m）. Conclusion Rathke＇s cleft cyst is not a rare disease. Therapy strategy is different form others intrasellar cystic lesions. We＇d better diagnosis preoperation accurately, and determine suitable treatment to method improve outcome.

关 键 词：鞍内 拉克囊肿 手术治疗 

分 类 号：R269.558[医药卫生—中西医结合]