鞍上生长Rathke囊肿临床特点及神经内镜治疗效果分析

Clinical characteristics and endoscopic treatment of suprasellar Rathke cleft cysts

目的比较鞍内-鞍上型和鞍上型Rathke囊肿(rathke cleft cyst,RCC)的临床特点,探讨经鼻内镜对鞍上型RCC的治疗效果。方法回顾性分析2013年1月至2018年8月于我院经鼻内镜治疗的鞍内-鞍上型RCC 61例,鞍上型RCC 15例,比较其临床表现、手术情况及效果。结果鞍上型RCC直径小于鞍内-鞍上型[(13.1±2.0)vs(17.5±4.2)mm,P<0.001],鞍上型RCC术前视力下降、视野缺损和高泌乳素血症发生率均高于鞍内-鞍上型(60.0%vs 27.9%,66.7%vs 37.7%,46.7%vs 19.7%,P均<0.05)。鞍上型手术时长及术后住院时长均显著大于鞍内-鞍上型[(136±21)vs(106±33)min,P=0.001;(11.7±2.7)vs(5.8±3.1)d,P<0.001]。鞍上型术后新发尿崩、颅内感染及低钠血症发生率均高于鞍内-鞍上型(33.3%vs 8.2%,20.0%vs 1.6%,46.7%vs 14.8%,P均<0.05)。随访(50.4±19.8)个月,其中鞍上型术后复发率也高于鞍内-鞍上型(26.7%vs 6.6%,P<0.05)。结论鞍上型RCC在体积较小时即可存在更高的术前视力视野受损、高泌乳素血症;术后新发尿崩、颅内感染、低钠血症的发生率更高,手术用时和术后住院时间更长。神经内镜下扩大经蝶入路是治疗鞍上型RCC有效、安全的方法。

Objective To compare the clinical characteristics between intrasuprasellar and suprasellar Rathke cleft cyst(RCC),and investigate the therapeutic efficacy of endoscopy for suprasellar RCC.Methods We retrospectively analyzed 61 intrasuprasellar and 15 suprasellar RCC treated by endoscopic endonasal approach(EEA)(standard or extended)in our hospital between January 2013 and August 2018.Their clinical manifestations,surgical conditions and outcomes were compared between the 2 groups.Results The cyst size was significantly smaller in suprasellar RCC than those in intrasuprasellar region(13.1±2.0 vs 17.5±4.2 mm,P<0.001).The patients with suprasellar RCC were more commonly presented with visual loss,visual field defect and hyperprolactinemia than those with intrasuprasellar RCC(60.0%vs 27.9%;66.7%vs 37.7%,P<0.05).The duration of surgery and postoperative hospital stay were significantly longer in the suprasellar RCC group than the intrasuprasellar group(136±21 vs 106±33 min,P=0.001;11.7±2.7 vs 5.8±3.1 d,both P<0.001).The incidences of new-onset diabetes insipidus,intracranial infection and hyponatremia were obviously higher in the former group than the latter group(33.3%vs 8.2%,20.0%vs 1.6%,46.7%vs 14.8%,all P<0.05).During the follow-up of 50.4±19.8 months,higher recurrence rate was observed in the suprasellar RCC group than the intrasuprasellar RCC group(26.7%vs 6.6%,P<0.05).Conclusion Compared with intrasuprasellar RCC,suprasellar RCC,even though in smaller size,may present higher incidences of preoperative visual loss and field defect and hyperprolactinemia before operation,and more common new-onset diabetes insipidus,meningitis and hyponatremia postoperatively,as well as longer surgical period and hospital stay.Extended EEA is an effective and safe approach for the treatment of suprasellar RCC.