中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2015年
5期
369-373
,共5页
颅咽管瘤%垂体肿瘤%中枢神经系统囊肿%内窥镜检查%鼻外科手术
顱嚥管瘤%垂體腫瘤%中樞神經繫統囊腫%內窺鏡檢查%鼻外科手術
로인관류%수체종류%중추신경계통낭종%내규경검사%비외과수술
Craniopharyngioma%Pituitary neoplasms%Central nervous system cyst%Endoscopy%Nasal surgical procedure
目的 分析鞍区囊性病变患者的临床和影像学特征并总结内镜经鼻蝶入路手术治疗的手术经验.方法 回顾性分析2003年6月至2013年9月在天津市环湖医院经手术和病理确诊的鞍区囊性病变46例患者的临床资料,其中颅咽管瘤11例,囊性垂体瘤14例,Rathke囊肿12例,垂体脓肿9例.比较46例患者的临床特点、影像学特征、手术治疗方法及术后复发情况.结果 全部患者均采用内镜下经鼻蝶入路手术治疗.术后头痛缓解26例,未缓解8例;垂体功能者恢复正常18例,未恢复15例;尿崩症恢复正常8例,未恢复正常4例;视力、视野改善12例,未改善2例.全部病例随访6 ～72个月,术后复发7例,其中颅咽管瘤4例,垂体脓肿2例,囊性垂体腺瘤1例.无严重并发症及死亡病例发生.46例患者中颅咽管瘤患者发病年龄较小、视力和视野症状明显、肿瘤多位于鞍上、第三脑室压迫、手术易复发.囊性垂体腺瘤常呈囊实性,侵犯海绵窦、实性部分均匀强化.Rathke囊肿表现为单纯囊性,临床症状出现较晚.垂体脓肿病程短,容易出现尿崩症,多个激素水平低下,影像学检查可见病变环形强化.结论 鞍区囊性病变的临床特点和影像学特征互相重叠,但又有一定的特异性.内镜经鼻蝶入路微创手术治疗鞍区囊性病变是安全、有效的手术治疗方法.
目的 分析鞍區囊性病變患者的臨床和影像學特徵併總結內鏡經鼻蝶入路手術治療的手術經驗.方法 迴顧性分析2003年6月至2013年9月在天津市環湖醫院經手術和病理確診的鞍區囊性病變46例患者的臨床資料,其中顱嚥管瘤11例,囊性垂體瘤14例,Rathke囊腫12例,垂體膿腫9例.比較46例患者的臨床特點、影像學特徵、手術治療方法及術後複髮情況.結果 全部患者均採用內鏡下經鼻蝶入路手術治療.術後頭痛緩解26例,未緩解8例;垂體功能者恢複正常18例,未恢複15例;尿崩癥恢複正常8例,未恢複正常4例;視力、視野改善12例,未改善2例.全部病例隨訪6 ～72箇月,術後複髮7例,其中顱嚥管瘤4例,垂體膿腫2例,囊性垂體腺瘤1例.無嚴重併髮癥及死亡病例髮生.46例患者中顱嚥管瘤患者髮病年齡較小、視力和視野癥狀明顯、腫瘤多位于鞍上、第三腦室壓迫、手術易複髮.囊性垂體腺瘤常呈囊實性,侵犯海綿竇、實性部分均勻彊化.Rathke囊腫錶現為單純囊性,臨床癥狀齣現較晚.垂體膿腫病程短,容易齣現尿崩癥,多箇激素水平低下,影像學檢查可見病變環形彊化.結論 鞍區囊性病變的臨床特點和影像學特徵互相重疊,但又有一定的特異性.內鏡經鼻蝶入路微創手術治療鞍區囊性病變是安全、有效的手術治療方法.
목적 분석안구낭성병변환자적림상화영상학특정병총결내경경비접입로수술치료적수술경험.방법 회고성분석2003년6월지2013년9월재천진시배호의원경수술화병리학진적안구낭성병변46례환자적림상자료,기중로인관류11례,낭성수체류14례,Rathke낭종12례,수체농종9례.비교46례환자적림상특점、영상학특정、수술치료방법급술후복발정황.결과 전부환자균채용내경하경비접입로수술치료.술후두통완해26례,미완해8례;수체공능자회복정상18례,미회복15례;뇨붕증회복정상8례,미회복정상4례;시력、시야개선12례,미개선2례.전부병례수방6 ～72개월,술후복발7례,기중로인관류4례,수체농종2례,낭성수체선류1례.무엄중병발증급사망병례발생.46례환자중로인관류환자발병년령교소、시력화시야증상명현、종류다위우안상、제삼뇌실압박、수술역복발.낭성수체선류상정낭실성,침범해면두、실성부분균균강화.Rathke낭종표현위단순낭성,림상증상출현교만.수체농종병정단,용역출현뇨붕증,다개격소수평저하,영상학검사가견병변배형강화.결론 안구낭성병변적림상특점화영상학특정호상중첩,단우유일정적특이성.내경경비접입로미창수술치료안구낭성병변시안전、유효적수술치료방법.
Objective To analyze the clinical and imaging characteristics of patients with cystic lesions in sella region and to describe the experience of endoscopic transsphenoidal surgery.Methods Fourty-six cases of cystic lesions in sella region confirmed by surgery and pathology between June 2003 and September 2013 were retrospectively analysed.The clinical features,imaging,surgical technique and postoperative recurrence in 46 cases were presented.Results All lesions were resected through transsphenoidal endoscopic endonasal approach.Followed up lasted from 6 months to 6 years.Postoperatively,headache was recovered in 26 cases and wasn't recovered in 8 cases,visual was improved in 12 cases and wasn't improved in 2 cases,hypopituitarism was relieved in 18 cases and wasn't relieved in 15 cases,polyuria was disappeared in 8 cases and wasn't disappeared in 4 cases.Seven cases recurred,including 4 cases of craniopharyngioma,2 cases of pituitary abscess,1 case of cystic adenoma.There were no death and serious complication.The small age of onset,visual acuity and visual field symptoms,tumor in suprasellar,third ventricle compression was easy to occur in craniopharyngioma;cystic tumor,cavernous sinus invasion,the solid part homogeneous enhancement could be seen in cystic adenoma;Rathke cyst showed simple cystic,lighter clinical symptoms and a short course.Prone to diabetes insipidus,low multiple hormone level and the lesions of annular enhancement was more common in pituitary abscess.Conclusions The clinical features and imaging of cystic lesions in sella region feature overlap each other,but there are certain specificity.Transsphenoidal endoscopic endonasal approach for the surgery of cystic lesions in sella is effective and safe.
