鞍区Rathke囊肿的诊断与治疗  

Diagnosis and treatment of Rathke＇s cleft cyst in sellar region

作　　者：王守森[1] 肖德勇[1] 余英豪[2] 荆俊杰[1] 赵琳[1] 王如密[1] 

机构地区：[1]南京军区福州总医院神经外科,福州350025 [2]南京军区福州总医院病理科,福州350025

出　　处：《中华神经医学杂志》2013年第2期131-136,共6页Chinese Journal of Neuromedicine

基　　金：南京军区医学科技创新重点课题（112034）

摘　　要：目的分析鞍区Rathke囊肿（RCC）的影像特征，探讨诊断和治疗的策略。方法回顾南京军区福州总医院神经外科自2005年1月至2011年8月经手术治疗的32例鞍区RCC患者，其中2例伴发垂体腺瘤。分析其临床征象，特别是MRI和组织病理表现，剖析诊断和治疗的经验与教训。结果术前只有3例明确或可疑RCC。9例存在10个囊内结节，结节的MRJ信号呈多样性，RCC并非在T2加权像上总能清晰可见：2例结节呈靶心样改变。RCC内容物呈T1高信号不一定伴有较严重的症状。术后MRI复查26例，其中5例术后影像发现复发或残留。结论MRl无强化、信号均匀的鞍区囊内结节对RCC有诊断价值，呈靶心样的结节有确诊意义。诊断RCC症状和影像表现时不要忽略炎性反应因素。Objective To explore the diagnosis and treatment strategies of Rathke＇s cleft cysts （RCC） in the sellar region through analyzing their imaging characteristics. Methods Thirty-two patients with RCC in the sellar region, including two also with concomitant pituitary adenoma, admitted to and performed surgery in our hospital from January 2005 to August 2011, were chosen in our study. The clinical features, especially MR/and histological appearances, were retrospectively reviewed. The experiences on their diagnosis and treatment were summarized. Results Preoperatively, only 3 patients were diagnosed or suspected as RCC. MR images revealed 10 intracystic nodules in 9 patients; their MR signal intensity was variable; not all nodules on T2-weighted images were visualized. Two nodules had bull＇s eyelike changes. The hyper-intense content on T1- weighted images was not definitely associated with serious symptoms. Postoperative MR/revealed recurrence or residual lesion in 5 of 26 patients. Conclusion Intracystic nodules with homogenous intensity and non-enhancement under MR/ are unique for sellar RCC; Bull＇ s eyelike changes in the intracystic nodule under MR/might have value for confirming the diagnosis. Pituitary inflammation should not be neglected when the clinical symptoms and MR/findings of RCC are being explained.

关 键 词：RATHKE囊肿 诊断 囊内结节 显微外科手术 

分 类 号：R651[医药卫生—外科学]