垂体脓肿的诊断与治疗(附9例临床分析)

Diagnosis and treatment of pituitary Abscess(clinical analysis of 9 cases)

目的探讨垂体脓肿的临床特点和治疗方法。方法回顾性分析9例垂体脓肿患者的临床表现、影像学特征、诊断和治疗,并结合文献进行分析。结果9例患者中有8例经鼻蝶入路手术,1例行大脑开颅手术。视功能改善77.8%(7/9),头痛缓解83.3%(5/6),垂体功能低下改善25%(1/4),尿崩症缓解33.3%(1/3)。结论垂体脓肿的发生有增多趋势;当患者头痛、视力视野障碍、垂体功能低下,尤其有尿崩的出现,结合影像学检查,鞍区磁共振及增强示类圆形囊状占位性病变,等或长T1,长T2,囊壁呈环形强化("鸭梨"征)等,应考虑垂体脓肿的诊断。诊断一旦确定,应尽早行手术治疗,入路以经蝶为首选;术后予抗感染、补充激素及对症等治疗。

Objective To discuss the clinical features and treatment of pituitary abscess. Methods Nine eases of pituitary abscess were analyzed retrospectively about clinical presentations, imaging features, diagnosis and treatment. Results Among 9 cases of pituitary abscess, 8 patients underwent a transspbenoidal surgery and 1 underwent a craniotomy surgery. Visual disturbance got improved by 77.8% （7/9） ; headache got relieved by 83.3% （5/6） ; hypopituitarism got improved by 25% （1/4） ; polyuria-polydipsia got relieved by 33.3% （ 1/3 ）. Conclusion Pituitary abscess has an obvious tendency of increasing. A diagnosis of pituitary abscess should be seriously considered when a patient presents headache, visual disturbance, hypopituitarism, or polyufia especially, combined with radiographic features of a sellar mass, iso- or hyperintense on T1 -weighted images, hyperintense on T2-weigbted images and ring enhancement （＂ pear sign ＂ ）. Operation via traussphenoidal approach should be performed as soon as possible when the diagnosis is made. Postoperative antibiotic and corticosteroid therapy should be taken properly.