垂体Rathke's囊肿性质与患者临床表现和预后的相关性分析

Analysis of relationship of pituitary Rathke's cleft cyst texture with clinical symptoms and prognosis

目的探讨垂体Rathke＇s囊肿物理性状与患者症状和预后的关系。方法回顾性分析2005年4月至2013年5月手术治疗的104例垂体Rathke＇s囊肿患者的临床资料,其中87例病人术后随访5~92个月,平均26.6个月。结果本组囊肿直径为8~30 mm,平均（15.3±5.0）mm,其中〈10 mm 7例,10~20 mm 69例,≥20 mm 28例。囊液含结晶54例,无结晶50例;囊液清亮37例,囊液粘稠67例。术后3个月复查MRI示囊肿全切除85例,囊肿残留2例;全切率为97.7%。术后复发3例,复发率为3.4%。头晕患者囊液含结晶的比例明显高于无头晕的患者（P〈0.05）;垂体激素水平异常的患者囊液含结晶的比例明显高于垂激素正常的患者（P〈0.05）;视力减退患者囊肿直径明显大于无视力减退者（P〈0.01）。结论垂体Rathke＇s囊肿囊内少量结晶与头晕有关,而大量结晶与垂体激素水平异常有关。手术治疗Rathke＇s囊肿的效果良好,术后并发症少,复发率低;术中处理好囊肿的分隔及囊内结晶是避免Rathke＇s囊肿残留与复发的关键。

ObjectiveTo explore the relationship of pituitary Rathke＇s cleft cysts textures with the clinical symptoms andprognoses in patients with symptomatic pituitary Rathke＇s cleft cysts undergoing surgery.MethodThe clinical data of 104 patients withpituitary Rathke＇s cleft cysts, who underwent surgery from April, 2005 to May, 2013, were analyzed retrospectively. Eighty-sevenpatients were followed up from 5 to 92 months（mean, 26.6 months）.ResultsThe diameters ranged from 8 to 30 mm [mean,（15.3±5.0）mm]. MRI 3 months after the surgery showed that of 87 patients 85（97.7%） received the total resection of the cysts and 2 had residualcysts. The cleft cysts recurred in 3（3.4%） patients. The occurrent rate of dizziness（41.0%, 16/39） was significantly higher in the patientswith few intracystic crystals than that（16.0%, 8/50） in the patients without intracystic crystals（P〈0.05）. The occurrent rate of abnormalpituitary hormone level（73.3%, 11/15） was significantly higher in the patients with many intracystic crystals than that（40%, 20/50） inthe patients without intracystic crystals（P〈0.05）. The cystic diameter [（17.9±5.1） mm]was bigger in the patients with visual disturbancecaused by the cleft cysts than that [（14.1 ± 4.5） mm] in the patients without visual disturbance（P0〈.05）.ConclusionsThe clinicalsymptoms are related to the cysts textures in the patients with pituitary Rathke＇s cleft cysts. The few intracystic crystals predispose thepatients to dizziness and a large number of the intracystic crystals predispose the patients to abnormal hormone level in the patients withpituitary Rathke cleft cysts. The curative effect of surgery on the pituitary Rathke＇s deft cyst is good. The complications are fewer and therecurrent rate is lower after the surgery in the patients with pituitary Rathke＇s cleft cysts. The removal of cystic separation and intracysticcrystals by the surgery are the keys to prevention of the cystic relapse.