热带病与寄生虫学

热带病与寄生虫学 ›› 2014, Vol. 12 ›› Issue (1): 53-55.doi: 10.3969/j.issn.1672-2302.2014.01.018

• 论著 • 上一篇    下一篇

内镜下经鼻-蝶窦微创手术治疗Rathke囊肿的效果

王彬,王文华,韩志强,侯立军*   

  1. 中国人民解放军第二军医大学附属长征医院神经外科（王彬、侯立军），中国人民武装警察部队上海市总队医院神经外科（王文华、韩志强）；*通讯作者
  • 出版日期:2014-03-10 发布日期:2014-05-12

Efficacy of endoscopic endonasal transphenoidal microsurgical treatment for Rathke’s cleft cysts

Wang Bin1, Wang Wenhua2, Han Zhiqiang2, Hou Lijun1*.   

  1. 1. Department of Neurosurgery, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai 200003, China. 2. Department of Neurosurgery,
    Shanghahi General Hospital of Chinese People’s Armed Police Forces, China. * Corresponding author.
  • Online:2014-03-10 Published:2014-05-12

被引次数

2

摘要： 目的 探讨内镜下经鼻-蝶窦微创手术治疗鞍区占位Rathke囊肿的效果。方法 回顾性分析12例经鼻-蝶窦内镜下切除、且经病理证实的Rathke囊肿病例资料，结合文献对Rathke囊肿的组织起源、发病机理、诊断、手术治疗及预后进行探讨。结果 12例Rathke囊肿病例根据解剖分为3种类型：纯鞍区占位（4例）、鞍区及鞍上延伸占位（7例）和纯鞍上占位（1例）。头痛是术前主要症状（9/12，75%），术后头痛症状均得到改善；5 例最初表现为严重视力下降（5/12，41.67%），术后有所改善；4例垂体功能障碍（4/12，33.33%）术后得到改善，所有病例均无永久性垂体功能障碍；1例术后脑脊液漏，经颅底重建和腰池外引流后改善；2例复发囊肿，其中1例再次接受手术治疗，另1例拒绝再次手术。结论 内镜下经鼻-蝶窦手术治疗Rathke囊肿安全、有效，术后并发症较少。

关键词: Rathke囊肿, 神经内镜, 微创手术, 治疗效果

Abstract:

Objective To assess the efficacy of endoscopic endonasal transphenoidal microsurgery for the treatment of Rathke’s cleft cysts. Methods A total of 12 cases with pathological diagnosis of Rathke’s cleft cysts who underwent endoscopic endonasal transphenoidal microsurgical treatment were retrospectively analyzed, and the origin, pathogenesis, diagnosis, surgical therapy and prognosis of Rathke’s cleft cysts were investigated by literature review. Results A total of 12 cases with Rathke’s cleft cysts were classified into three types based on anatomy, space-occupying in the sellar region (4 cases), space-occupying in the sellar and suprasellar region (7 cases) and space- occupying in the suprasellar region (1 case). Headache was the predominant pre-surgical symptom (9/12, 75%), and all had improvements in the headache symptoms after surgery. Five cases (41.67% ) had severe reduced vision initially, which improved after surgery. Pituitary
disorders were improved in four cases (33.33% ) following surgery. All cases had no permanent pituitary disorders. One case had post- surgical cerebrospinal leakage, which improved following skull base reconstruction and lumbar cistern drainage. Of the two cases with recurrent Rathke’s cleft cyst, one underwent
surgical therapy again, and the other rejected the surgery. Conclusion Endoscopic endonasal transphenoidal microsurgical therapy is safe and effective for the treatment of Rathke’s cleft cysts, with few post-surgical
complications seen.

Key words: Rathke’s cleft cyst, Endoscopy, Minimally invasive surgery, Therapeutic efficacy