| 摘要: |
| 目的 探讨症状性Rathke囊肿的诊断及手术治疗。方法 回顾性分析2001年1月至2010年10月收治的23例经手术和病理证实的症状性Rathke囊肿患者的临床资料。其中男性9例、女性14例；主要临床表现为头痛15例(65.2%)，视力下降和(或)视野缺损8例(34.8%)，下丘脑-垂体功能紊乱11例(47.8%)。头颅MRI检查发现完全鞍内型病变10例，鞍内-鞍上扩展型10例，完全鞍上型3例。16例采用经鼻中隔-蝶窦入路手术，7例经右侧翼点入路手术，术中彻底清除囊内容物，完整或部分切除囊壁，开放囊腔。结果 随访14个月至10年，术后头痛缓解13例(13/15)，下丘脑垂体功能紊乱缓解7例(7/11)，视觉障碍均得到改善(8/8)。随访期间复发1例。结论 症状性Rathke囊肿临床特点及影像学表现多样，术前明确诊断较困难。一般可经鼻中隔-蝶窦入路清除病灶，完全鞍上型病变则需选择经颅入路。显微镜下手术清除囊内容物并在确保安全前提下切除囊壁组织，既可明确诊断，又能缓解症状；是有效的治疗策略。 |
| 关键词: Rathke囊肿 诊断 显微外科手术 预后 |
| DOI：10.3724/SP.J.1008.2012.00399 |
| 投稿时间：2011-12-25修订日期：2012-03-31 |
| 基金项目:上海市科技发展基金攻关计划项目 |
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| Diagnosis and microsurgical treatment of symptomatic Rathke cleft cysts in23 cases |
| XIE Tian-hao,QIAN Jun,LIU Fei-li,JIANG Yi-kun,LU Yi-cheng,LUO Chun* |
(Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai200003, China
*Corresponding author.) |
| Abstract: |
| Objective To discuss the diagnosis and surgical treatment of symptomatic Rathke cleft cysts (RCCs). Methods Twenty-three symptomatic RCCs, who were verified by microsurgeries and pathological examination from Jan. 2001 to Oct. 2010, were retrospectively analyzed. Nine of them were males and fourteen of them were females. The main clinical manifestations included headache (65.2%), visual disturbance (34.8%) and pituitary dysfunctions (47.8%). The magnetic resonance imaging (MRI) showed 10 pure intrasellar lesions, 10 lesions of intrasellar with a suprasellar extension, and 3 pure suprasellar lesions. Sixteen cases were treated by transsphenoidal microsurgery and 7 were treated by craniotomy. The contents of the cysts were drained totally during the operation, and part of or the total cyst wall were safely moved and kept open. Results Postoperative follow-up period ranged from 14 months to 10 years. All the 8 patients were released from visual disturbance. Headache was improved in 13 of the 15 patients and pituitary dysfunction was improved in 7 of the 11 patients. Recurrence was noted in 1 patient. Conclusion Preoperative definite diagnosis for the symptomatic RCCs is difficult due to a variety of clinical manifestations and MRI signals. Most of the lesions can be treated via transsphenoidal approach. Transcranial approach is necessary for the pure suprasellar RCCs. Microsurgery is an effective strategy for the treatment of symptomatic RCCs, because it can safely relieve the symptoms and make definite diagnosis. |
| Key words: Rathke cleft cysts diagnosis microsurgery prognosis |
