亚临床垂体腺瘤卒中的诊断与治疗  

Diagnosis and treatment of subclinical pituitary apoplexy: report of 21 cases

作　　者：沙成[1] 高平[2] 杨玉明[1] 谢红雯[1] 王兴文[1] 刘树山[1] 

机构地区：[1]卫生部北京医院神经外科,100730 [2]卫生部北京医院神经内科,100730

出　　处：《中华外科杂志》2002年第10期755-757,共3页Chinese Journal of Surgery

摘　　要：目的　总结亚临床垂体腺瘤卒中的临床特点 ,探讨其诊断方法及手术疗效。　方法回顾性分析了 1989年 10月～ 2 0 0 1年 11月收治的 2 1例亚临床垂体腺瘤卒中患者的临床表现和治疗情况。　结果　这些患者的主要临床表现为慢性头痛、视力视野改变及垂体腺瘤体征 ,其中 3例无任何临床症状。 2 0例患者行显微手术治疗 (其中急诊手术 3例 ) ,经口 鼻 蝶入路 17例 ,经翼点入路 3例 ;保守治疗 1例。术前激素替代治疗 12例。术后视力明显改善 7例 ,部分改善 8例 ,无变化 4例 ,恶化 1例。结论　亚临床垂体腺瘤卒中患者无典型临床表现 ,临床上易误诊而延误治疗。颅脑MRI检查是准确诊断垂体腺瘤卒中的最佳手段。经蝶手术安全有效 ,及时地激素替代疗法及早期手术是治疗患者严重视力障碍的有效方法。Objectives To evaluate clinical manifestations of 21 patients with subclinical pituitary apoplexy and their diagnosis and treatment. Method Clinical data from 21 patients with subclinical pituitary apoplexy treated from October 1989 to November 2001 were analyzed retrospectively. Results Their clinical manifestations included chronic headache, visual deficit and field cut. Three patients showed no clinical signs. Microsurgery was performed in 20 patients, of whom 3 were treated by emergency operation. Microsurgery included transsphenoidal decompression in 17 patients, and transpterioral approach in 3. One patient was given conservative therapy, and 12 were given endocrine replacement therapy. Nineteen patients recovered with marked visual improvement (7), partial improvement (8), no changes (4); deterioration was noted in 1. Conclusions Subclinical pituitary apoplexy characterized by atypical clinical manifestations may be misdiagnosed or in appropriately treated. MRI is superior to CT scan for the diagnosis of subclinical pituitary apoplexy. Patients with persistent chiasmatic syndromes are indicated for emergency surgery. Endocrine replacement and transsphnoidal decompression are effective for the improvement of severe visual disturbance.

关 键 词：亚临床垂体腺瘤 垂体卒中 诊断 手术治疗 临床特点 

分 类 号：R736.4[医药卫生—肿瘤]