41例垂体Rathke囊肿的诊断和手术治疗

Diagnosis and Treatment of Microsurgery of Rathke's Cleft Cysts

目的:分析和讨论垂体Rathke(拉克氏)囊肿的诊断和手术治疗。方法:回顾分析41例经手术和病理证实的垂体Rathke囊肿的病例,男性16例,女性25例;年龄13～67岁,平均32.8岁,平均病程为20.6个月。主要临床表现:头痛26例(63.4%)、垂体功能紊乱23例(56.1%)、视功能障碍13例(31.7%),CT及MRI检查发现鞍区囊性肿物。39例采用经口鼻蝶窦入路显微外科手术,2例采用开颅手术,切除部分囊壁,敞开囊腔,清除囊肿内容物。结果:术前正确诊断为垂体Rathke囊肿的仅为7例,术后随诊3个月至8年,头痛患者的症状全部缓解,垂体功能紊乱患者(13/23)56.5%得到改善,视功能障碍患者(10/13)76.9%得到改善。41例患者术后均无复发。结论:垂体Rathke囊肿术前较难明确诊断,MRI检查信号呈多样性,无特异性。经口鼻蝶窦入路显微外科手术可以明确诊断,缓解症状,患者预后良好,是治疗垂体Rathke囊肿的有效方法。

Objective:To discuss the diagnosis and treatme nt of surgery of Rathke's cleft cysts.Methods:41cases of Rathke's cleft cysts who were treated by microsurgery and diagnosed through pathological results were rev iewed.16of them were male and25were female.Mean age were32.8years old.Duration o f symptoms were20.6months in average.The main clinical manifestation included he adache(63.4%),pituitary dysfunction(56.1%)and visual interference(31.7%).Compute d Tomography and Magnetic Resonance Imaging showed cystic mass in the area of se lla turcica.39cases were treated by transsphenoidal microsurgery and2cases were treated through craniotomy.In the operation,the content of the cysts were moved and drainaged,the cyst wall were partially moved and keeped opening.Results:Befo re the operation,only7cases were correctly diagnosed.In the follow)up period fro m3months to8years,symptom of headache were all resolved(26/26),pituitary dysfunc tion were resolved in56.5%(13/23)and visual interference in76.9%(10/13).No patie nt recurred.Conclusions:It is difficult to establish the correct diagnosis of Ra thke's cleft cysts before operation.The Magnetic Resonance Imaging signal was mu ltiple and nonspecific.Transsphenoidal microsurgery can prove the diagnosis,re) solve the symptoms,is the effective way to treat the Rathke's cleft cysts.