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1、军医进修学院学报2004Feb,25(1)12AcadJPLAPostgradMedSch[文章编号]10051139(2004)01001203Rathke裂囊肿的诊断和治疗魏少波,周定标,潘隆盛,朱儒远(解放军总医院神经外科,北京100853)[摘要]目的:提高Rathke裂囊肿的诊断和治疗水平。方法:回顾性研究1993年到2002年,在我院经蝶手术的33例Rathke裂囊肿,术前头痛占788%,垂体功能紊乱占624%,视力减退273%。X线平片蝶鞍扩大者占152%,CT呈
2、高密度者占615%,MRIT1像显示636%的囊肿呈高信号,152%等信号,121%低信号,91%混合信号,囊肿均不被强化。33例均经蝶入路手术切除病变。结果:术后100%患者的视力改善,846%头痛消失或减轻,727%月经恢复,667%乏力感消失,50%体重明显减轻。结论:Rathke裂囊肿垂体功能紊乱发生率比人们估计为高;如发现鞍内一囊性结构,CT显示为高密度,MRIT1像表现为高或低信号,强化后无增强,应考虑为Rathke裂囊肿;绝大多数Rathke裂囊肿可经鼻蝶入路清除病灶,并能有效地
3、改善临床症状及垂体功能;积极手术治疗,即使是病人有轻微的症状和体征,以免发生不可逆转的垂体功能低下。[关键词]垂体疾病;Rathke裂囊肿;神经外科手术[中图分类号]R6511[文献标识码]ADiagnosisandtreatmentofRathkescleftcystsWEIShaob0,ZHOUDingbiao,PanLongsheng,ZHURuyuan(DepartmentofNeurosurgery,PLAGeneralHospital,Beijing100853,China)[
4、Abstract]Objective:ToraisethediagnosandtreatmentlevelofRathkescleftcystsMethods:WeretrospectivelyrevieweddatacollectedonRathkescleftcystsbetween1993and2002,33patientspresentingsymptomsweretreatedbytranssphenoidalsurgeryBeforetheoperation,headachewaspr
5、esentin788%,pituitarydysfunctionin624%andvisualinterferencein273%,enlargementofthesellaturcicaonplainxraysin152%CTshowedhighdensitylesionin615%,andMRIshowedhighintensityonT1weightedimageslesionin636%,isointensityin152%,lowintensityin121%,andothe
6、rsin91%andnoenhancementinallofcasesAllpatientsweretreatedbyatranssphenoidalsurgeryResults:Postoperativevisualdisturbanceimprovedin100%ofpatients,headacheswereresolvedin846%,Amenorrhearecoveredorimprovedin727%Conclusions:Resultsofthepresentstudyindica
7、te:1)TheincidenceofpituitarydysfunctioninpatientswithRathkescleftcystishigherthansuspected2)WhenanonenhancingcystlikestructureinthesellaturcicawithCTshowedhighdensityandMRIshowedhighintensityorlowintensityonT1isdemonstrated,thepossibilityofRathkesclef
8、tcystshouldbeconsidered3)MostRathkecleftcystscanbetreatedbyatranssphenoidalsurgeryandinmostcasessurgicalinterventionimprovespituitaryfunctionandtheclinicalstatusofthepatient4)Surgicaltreatmentisre
