神经内镜下经鼻蝶入路治疗Rathke’s囊肿  

Neuroendoscopic transnasal transsphenoidal approach for the treatment of Rathke's cleft cyst

作　　者：吴小军 郝斌[1] 曹依群[1] 李良东 周长帅 陈鑫[1] Wu Xiaojun;Hao Bin;Cao Yiqun;Li Liangdong;Zhou Changshuai;Chen Xin(Department of Neurosurgery,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院神经外科复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中国微侵袭神经外科杂志》2024年第3期148-152,共5页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的研究神经内镜技术治疗Rathke’s囊肿(Rathke’scleft cysts,RCC)的有效性。方法回顾性分析34例RCC病例资料,均采用神经内镜技术治疗,对比手术前后病人头疼、视力障碍、内分泌障碍等症状的改善,以及术后脑脊液漏的发生与囊肿复发情况等。结果33例采用内镜下囊肿开窗或囊壁部分切除术,1例囊壁全切除。术前有头疼症状21例(61.8%),术后1周~12个月头疼症状改善9例。术前视力下降9例(26.5%),术后改善2例。术前垂体功能异常21例(61.8%),术后恢复正常7例。1例囊壁全切除病人,术后持续性脑脊液漏,保守治疗1个月后行二次手术修补。复发2例(5.9%),1例随访未手术,1例2年后囊肿萎缩消失。无手术相关死亡。结论神经内镜技术可用于治疗出现头疼、视力下降、激素水平改变的RCC病人。Objective To investigate the effectiveness of neuroendoscopic techniques in the treatment of Rathke's cleft cysts(RCC).Methods The clinical data of 34 cases of RCC were retrospectively analyzed,and all of them were treated with neuroendoscopic technology,and the improvement of symptoms such as headache,visual impairment and endocrine disorder before and after surgery,as well as the occurrence of postoperative cerebrospinal fluid(CSF)leakage and cyst recurrence were compared.Results Thirty-three patients underwent cyst fenestration or partial resection of the cyst wall,and 1 patient had total excision of the cyst wall.Preoperatively,21 patients(61.8%)presented headache symptoms and 9 showed improvement from 1 week to 12 months after surgery.Visual acuity decreased in 9 cases(26.5%)before surgery and improved in 2 cases after surgery.There were 21 patients(61.8%)with abnormal pituitary gland function before operation,and 7 recovered to normal after surgery.One patient with excision of the cyst wall had persistent CSF leakage after surgery,and underwent secondary surgical repair after 1 month of conservative treatment.There were 2 cases(5.9%)of recurrence,1 was not operated during follow-up,and another one had RCC atrophy and disappeared after 2 years.There was no perioperative mortality.Conclusion Neuroendoscopic techniques can be used to treat patients with RCC who have headaches,decreased vision,and altered hormone levels.

关 键 词：Rathke’s囊肿 鞍区 内镜 脑脊液漏 

分 类 号：R739.41[医药卫生—肿瘤] R730.2[医药卫生—临床医学]