首诊于眼科的鞍区肿瘤45例

The first consultation in the Eye of the 45 cases of sellar tumors

目的:分析鞍区肿瘤的早期眼科临床表现,以减少误诊和漏诊。方法:回顾性分析了首诊于眼科,确诊为鞍区肿瘤的45例患者,眼科门诊常规检查:包括裸眼视力、矫正视力、瞳孔反射、散瞳眼底检查、眼压、计算机辅助中心视野检查(Humphrey)、鞍区CT平扫和加强,对其临床表现、病程、体征、辅助检查以及预后进行综合分析。结果:视力:无光感5眼;光感～0.1者6眼;0.12～0.4者35眼,0.5～0.8者39眼,≥1.0者5眼。散瞳检查眼底:早期视乳突水肿42眼,视神经乳头色红,边界模糊,生理凹陷消失,多在1.00～2.00D以下,视网膜静脉充盈、变粗。病程后期视神经乳头水肿34眼,视神经乳头直径变大,呈菌型隆起,多在3.00D以上,11眼视神经乳头表面有出血,视网膜静脉怒张、迂曲。视神经萎缩14眼。中心视野检查:双眼颞侧偏盲27例,单眼颞侧偏盲15例。鞍区CT扫描和加强:发现垂体瘤30例,颅咽管瘤8例,鞍结节脑膜瘤4例,碟骨嵴脑膜瘤3例。结论:鞍区肿瘤大多首诊于眼科,熟悉鞍区的解剖,加强神经眼科知识的学习,重视临床表现,完善辅助检查特别是重视眼底表现和视野改变可以提高鞍区肿瘤的诊断率。

AIM： Analysis clinical manifestations of early tumors in the sellar region ophthalmic, in order to reduce the misdiagnosis and missed diagnosis.METHODS：Retrospective analysis of the first consultation in ophthalmology. 45 cases of patients was confirmed by sellar region with tumors. Ophthalmic out-patient routine examination including., uncorrected visual acuity, corrected visual acuity, pupillary reflex, fundus examination, intraocular pressure, computer-assisted central visual field examination （Humphrey）, CT scan sellar region and strengthen its clinical manifestations, pathogenesis, signs, examination and comprehensive analysis of the prognosis.RESULTS： Visual acuity, no light perception in 5 eyes; light perception to 0.1 were 6; from 0.12 to 0.4 were 35, 0.5 to 0.8 were 39, ≥1.0 in 5 eyes. Fundus examination. Early edema as the mastoid 42, the optic nerve papilla color red, fuzzy boundaries, physiological depression disappeared, and more in the following 1. 00-2. 00D, retinal vein filling. The late course of 34 papilledema, optic papilla diameter larger bulge-type strain was more in the 3. 00D more than 11 surface of the optic papilla bleeding, retinal vein, tortuous. Optic atrophy 14. Central visual field examination： eyes 27 cases of temporal, monocular temporal 15 cases. Sellar region and the strengthening of CT scan; found 30 cases of pituitary tumor, craniopharyngioma eight cases, four cases of tuberculum sellae meningioma, dish three cases of bone ridge meningiomas.CONCLUSION, Most of the first tumor clinic in the ophthalmology. Familiar with the anatomy of sellar region, to strengthen the knowledge of neuro-ophthalmic,clinical performance.And improving the examination performance with particular emphasis placed on the eye and vision to change the sellar region can improve the diagnosis rate of oncology.