神经内镜经鼻蝶手术治疗Rathke囊肿的疗效观察和治疗体会  

Efficacy observation and treatment experience of neuroendoscopic transnasosphenoidal surgery for Rathke cysts

作　　者：丁哲旻[1,2] 朱爱华 王清 钱心炜 陆华[1,2] 冯素银[1,2] 徐然 鲁晓杰 Ding Zhemin;Zhu Aihua;Wang Qing;Qian Xinwei;Lu Hua;Feng Suyin;Xu Ran;Lu Xiaojie(Department of Neurosurgery,the Affiliated Hospital of Jiangnan University,Wuxi 214125,China;Neuromedical Center,Jiangnan University,Wuxi 214125,China;Department of Neurosurgery,Wuxi No.2 People′s Hospital,Wuxi 214062,China)

机构地区：[1]江南大学附属医院神经外科,无锡214125 [2]江南大学神经医学中心,无锡214125 [3]无锡市第二人民医院神经外科,无锡214062

出　　处：《中华神经外科杂志》2023年第2期162-166,共5页Chinese Journal of Neurosurgery

基　　金：无锡市卫生健康委青年项目(Q201838)。

摘　　要：目的探讨神经内镜经鼻蝶手术治疗Rathke囊肿的疗效和治疗体会。方法回顾性分析2018年1月至2021年6月江南大学附属医院神经外科(9例)和无锡市第二人民医院神经外科(19例)采用神经内镜经鼻蝶手术治疗的28例Rathke囊肿患者的临床资料。术中均个体化清除囊内容物,并行鞍底多层次修补。通过患者症状有无缓解、激素水平有无改善及鞍区MRI复查情况评估手术疗效。结果28例患者的Rathke囊肿均达全切除。14例头痛患者中,13例术后头痛缓解;9例视力、视野障碍的患者中,7例术后改善;6例内分泌功能异常的患者中,5例术后改善。5例患者术后出现一过性皮质醇或甲状腺功能低下,6例出现尿崩症,1例出现明显脑脊液漏。无一例发生颅内感染。28例患者的术后随访时间为(18.5±8.8)个月(3~36个月)。至末次随访,所有患者复查头颅MRI均未见Rathke囊肿复发。结论采用神经内镜经鼻蝶手术治疗Rathke囊肿的疗效和安全性均较好,术中予以个体化清除囊内容物、多层次鞍底修补,创伤小且并发症少。Objective To investigate the effectiveness and therapeutic experience of endoscopic treatment for Rathke cysts.Methods The clinical data of 28 patients with Rathke cysts who underwent endoscopic transnasosphenoidal surgery at the Department of Neurosurgery,the Affiliated Hospital of Jiangnan University(9 cases)and Wuxi No.2 People′s Hospital(19 cases)from January 2018 to June 2021 were retrospectively analyzed.All cases were treated by endoscopic transnasosphenoidal surgery with individualized intraoperative removal and multilevel sellar floor reconstruction.The effectiveness of endoscopic treatment for Rathke cyst was analyzed based on the improvement of symptoms,hormone levels and MRI review.Results All 28 Rathke cysts were completely resected by endoscopic transna-sosphenoidal surgery.Postoperative relief of headache was achieved in 13 out of 14 patients with headache,improvement was reported in 7 out of 9 patients with visual field disorders and 5 out of 6 patients with endocrine abnormalities.Transient cortisol or hypothyroidism occurred in 5 patients,diabetes insipidus occurred in 6 patients,and significant cerebrospinal fluid leakage occurred in 1 patient.No intracranial infection occurred.The postoperative follow-up time of 28 patients was 18.5±8.8 months(3-36 months).To the last follow-up,no recurrence of Rathke cyst was found in those patients in the re-examination of cranial MRI.Conclusions The efficacy and safety of neuroendoscopic transsphenoidal surgery for Rathke cysts are good.Individualized removal of cyst contents and multi-level sellar floors reconstruction are performed during the operation,with less trauma and fewer complications.

关 键 词：自然腔道内镜手术 中枢神经系统囊肿 治疗结果 经鼻蝶窦 

分 类 号：R651[医药卫生—外科学]