CAJ | 학술논문

目的提高对囊性垂体瘤(PA)、颅咽管瘤(CR)、蛛网膜囊肿(AC)和拉克氏囊肿(RCC)鞍内囊性占位病变的治疗方法和预后的认识.方法对72例鞍内囊性病人采取了经鼻蝶入路手术治疗.比较术前的临床表现,生化检查结果和神经影像特点及差异,给出初步诊断;术中进一步验证诊断,术中所见结合术前特点,选择不同手术策略;术后随访,观察临床症状变化,根据病理性质分组,观察病变复发情况.随访12～52个月,平均34个月.72例病变中:囊性PA 32例(44.4%),RCC 27例(37.5%),CR 10例(13.9%),AC 1例(1.4%).内分泌症状中CR有较明显的全垂体功能低下(8例,80%),PA(15例,55.6%)和RCC(12例,44.4%)中反馈性泌乳素轻度增高较其他病变多.结果 (1)影像学特点:囊性PA囊壁强化明显,强化部分为肿瘤成分;CR出现钙化的概率高(70%);典型的RCC位于垂体前叶和后叶之间,囊液信号多样;AC囊液同脑脊液信号,垂体被推挤向后方.(2)术后:术后占位征象均消失,CR需要长期的激素替代治疗(6例CR).其他几种疾病内分泌可在1～2个月内恢复正常.尿崩症出现的比例CR 9例(90%),RCC 11例(40.7%)高于其他两种疾病.(3)复发:PA复发1例,CR复发2例,RCC和AC没有复发.结论应了解各种鞍内囊性病变特点,诊断明确,采取不同的治疗策略,改善疾病预后.
목적 제고대낭성수체류(PA)、로인관류(CR)、주망막낭종(AC)화랍극씨낭종(RCC)안내낭성점위병변적치료방법화예후적인식.방법 대72례안내낭성병인채취료경비접입로수술치료.비교술전적림상표현,생화검사결과화신경영상특점급차이,급출초보진단;술중진일보험증진단,술중소견결합술전특점,선택불동수술책략;술후수방,관찰림상증상변화,근거병이성질분조,관찰병변복발정황.수방12～52개월,평균34개월.72례병변중:낭성PA 32례(44.4%),RCC 27례(37.5%),CR 10례(13.9%),AC 1례(1.4%).내분비증상중CR유교명현적전수체공능저하(8례,80%),PA(15례,55.6%)화RCC(12례,44.4%)중반궤성비유소경도증고교기타병변다.결과 (1)영상학특점:낭성PA낭벽강화명현,강화부분위종류성분;CR출현개화적개솔고(70%);전형적RCC위우수체전협화후협지간,낭액신호다양;AC낭액동뇌척액신호,수체피추제향 후방.(2)술후:술후점위정상균소실,CR수요장기적격소체대치료(6례CR).기타궤충질병내분비가재1～2개월내회복정상.뇨붕증출현적비례CR 9례(90%),RCC 11례(40.7%)고우기타량충질병.(3)복발:PA복발1례,CR복발2례,RCC화AC몰유복발.결론 응료해각충안내낭성병변특점,진단명학,채취불동적치료책략,개선질병예후.
Objective To make a clear distinction of intrasellar cystic lesions: craniopharyngioma (CR), Rathke's cleft cyst(RCC), cystic pituitary adenoma(PA)and intrasellar arachnoid cyst(AC).Methods A total of 72 adult patients underwent transsphenoidal approach for the removal of intrasellar cystic lesions. The authors conducted a study to(1)investigate preoperative clinical, biochemical and radiographic features of patients with CR, RCC, PA and AC;(2)identify clinicopathological features of independently predicting recurrence in CR, PA and RCC in adults. These adult patients included CR(n =10), RCC(n = 27), cystic PA(n=32)and 1 patient with AC(n = 1). Results The CR patients presented with hypopituitarism in 80% of cases. According to the biochemical criteria, the percentage of patients with a slight prolactin increase happened in PA(55.6%)and RCC(44. 4%). Cystic PA had postcontrasting enhancement in cyst wall because of rumor tissue. Calcification detectable on computed tomographic scanning was present in 70% of CR patients. It was a significantly greater proportion compared to other diseases. Typical RCC was located between anterior and posterior pituitary and the contents in RCC were variable. Mass effects vanished post-operatively in all kinds of lesions. Long-term hormone replacement therapy was administered more in CR patients(60%)and diabetes insipidus than other lesions. One PA patient and 2 CR patients had recurrence during a follow-up of 12-52 months(mean: 34). RCC and AC had no recurrence. Conclusion Craniopharyngioma, Rathke's cleft cyst, cystic pituitary adenoma and intrasellar arachnoid cyst are a spectrum of diseases with different therapeutic strategies. An accurate diagnosis of these lesions is essential so as to determine the type of treatment to improve outcome.