垂体脓肿的诊断和经蝶显微手术治疗

Diagnosis and surgical management of pituitary abscess

目的探讨垂体脓肿的诊断及治疗方法。方法回顾性分析我院15例垂体脓肿患者的临床表现、影像学特征、诊断和治疗。结果 15例患者中术前主要表现为头痛8例,视力下降或颞侧偏盲6例,垂体前叶功能低下7例,尿崩4例,发热1例。MRI增强示病灶均呈环形强化。15例患者均采用经鼻蝶手术入路清除脓肿。术后1 w,8例头痛患者症状均消失,6例视力下降患者中4例改善;术后随访至第3个月,4例尿崩患者有2例恢复正常,7例垂体功能减退患者中4例好转,另3例患者继续予以药物替代治疗;术后6个月,另2例仍多饮多尿患者和3例垂体功能仍低下者均恢复正常。15例患者均无复发。结论垂体脓肿术前诊断较困难,对鞍区囊性病变应考虑到垂体脓肿的可能性。及早采用微创手术、合理应用抗生素及恰当的对症治疗是治疗垂体脓肿的关键。

Objective To explore clinical features and treatment of pituitary abscess. Methods Clinical presentations, imaging features, diagnosis and treatment of 15 cases of pituitary abscess were analyzed retrospectively. Results Headache which was the most common clinical manifestation was presented in 8 cases, visual disturbance in 6 cases, anterior pituitary hypofunction in 7 cases, polyuria in 4 cases and fever in 1 case. MRI image revealed ring-enhancing pituitary lesion. All cases were treated surgically via transsphenoidal approach. One week after operation, headache disappeared in all cases and visual was improved in 4 cases. Three months after operation, polyuria disappeared in 2 cases and hypophysial function was found normal in 4 cases. Other 3 cases received drug replacement therapy because of remained anterior pituitary hypofunction. Six months after operation, the remained 3 patients who had anterior pituitary hypofunction and 2 patients who had polyuria got recovery and none of 15 cases got recurrence. Conclusion The preoperative diagnosis of pituitary abscess is difficult. The possibility of pituitary abscess should be considered in pituitary cystic lesion. Appropriate minimal invasive approach, proper antibiotics and symptomatic therapy are the keys to the treatment of pituitary abscess.