垂体脓肿的诊断和治疗

Diagnosis and management of pituitary abscess:a report of 11 cases

目的探讨垂体脓肿的临床表现、影像学特点、诊断和治疗,提高对垂体脓肿的诊断及治疗水平。方法回顾性分析11例垂体脓肿患者的病史、临床表现、影像学表现、实验室检查结果、诊断和治疗过程,以及随访结果。结果11例患者中男6例,女5例。年龄23~71岁。临床表现为头痛、头晕、恶心、呕吐、多尿、视力下降、发热、月经紊乱等。磁共振平扫表现为鞍区或鞍上区囊性病变,增强扫描为均匀或不均匀环形强化。7例患者采用抗菌药物抗感染治疗,4例患者采用手术治疗。11例患者随访时间3个月至8年,未见脓肿复发。结论垂体脓肿病史和临床表现多不典型,蝶窦炎及垂体前叶功能低下有助于垂体脓肿鉴别诊断。早期足量足程抗菌药物可作为垂体脓肿的首选治疗方法及诊断性治疗方法,经鼻蝶窦手术作为垂体脓肿抗菌药物治疗方法的补充,疗效确切。垂体脓肿总体预后良好。

Objective To investigate the clinical manifestations,imaging features,diagnosis and management of pituitary abscess,and to improve the diagnosis and management of pituitary abscess.Methods The history,clinical manifestations,imaging manifestations,laboratory examination results,diagnosis and management process,and follow-up results of 11 patients with pituitary abscess in our hospital from January 2010 to September 2019 were retrospectively analyzed.Results There were 6 males and 5 females.The age was 23-71 years old.The clinical manifestations included headache,dizziness,nausea,vomiting,polyuria,decreased vision,fever,menstrual disorder,and etc.MR scan showed cystic lesions in sellar or suprasellar region;and enhanced scan showed uniform or uneven ring enhancement.Seven patients were cured by antibiotic therapy,and 4 patients were treated by operation.The followed-up were 3 months to 8 years,no recurrence was reported.Conclusion The history and clinical manifestations of pituitary abscess are not typical.MR imaging shows sphenoid sinusitis,and hypofunction of anterior pituitary are helpful for differential diagnosis of pituitary abscess.Early sufficient antibiotics can be used as the first choice and diagnostic management for pituitary abscess.Transsphenoidal surgery has a definite effect as the supplement to the antibiotics treatment.The overall prognosis of pituitary abscess is good.