伴有Rathke囊肿的垂体腺瘤的临床诊断和治疗

Diagnosis and treatment of pituitary adenoma combined with Rathke 's cleft cyst

目的总结伴有Rathke囊肿垂体腺瘤的临床特点、诊断和手术治疗方法。方法回顾性分析11例经手术病理证实伴有Rathke囊肿垂体腺瘤的临床特点,影像学表现及其手术治疗效果。结果 11例患者全切9例,次全切除2例,囊肿均切除,术后均进行临床随访,随访时间8～52个月,术前视力下降的7例患者术后视力得到明显改善,其中6例患者视力恢复正常,3例月经紊乱患者月经恢复,1例头痛患者术后头痛消失。术后复查垂体磁共振未见肿瘤或囊肿复发。结论伴有Rathke囊肿的垂体腺瘤临床罕见,垂体MRI提示肿瘤内存在囊性信号应考虑合并Rathke囊肿的存在,压迫症状明显的患者可选择手术治疗,预后良好。

Objective To summarize clinical features, diagnosis and surgical treatment of pituitary adenoma combined with Rathke ＂s cleft cyst. Methods The clinical features, imaging findings and surgical treatment of 11 patients pathologically confirmed pituitary adenoma combined with Rathke ＂s cleft cyst were analyzed retrospectively. Results Total resection of nine cases, subtotal resection in 2 cases of 11 patients, Rathke＇s cleft cysts were totally removed. The follow-up time was 8-52 months, seven cases of vision loss preoperative significantly improved, among which 6 patients vision returned to normal; 3 patients＇ menstrual recovered, one case＇ s headache disappeared. The MRI after operation showed no tumor or cyst recurrence. Conclusion Pituitary adenoma associated with Rathke cyst should be taken into account when pituitary MRI suggests cystic signal. It is rare and the treatment is the same as the pituitary adenoma, surgery may be the choice when the patient shows vision loss or pituitary dysfunction. The prognosis is good.