垂体脓肿诊断及治疗(附5例报告).docVIP

垂体脓肿诊断及治疗（附5例报告） 杨恒、韩国强、刘窗溪、高方友、尹浩、熊云彪、王俊 【摘要】目的 探讨垂体脓肿的临床诊断和治疗。方法 回顾性分析5例垂体脓肿病例，对其病史、临床表现、影像学及内分泌检查结果、治疗方法及随访资料进行总结分析。结果 5例均无颅内及全身感染症状，头痛头昏5例、视力视野障碍者3例、垂体功能异常4例、尿崩1例，5例均行单鼻孔蝶窦手术治疗，其中术后复发1例。术后随访2月~4年视力视野障碍明显改善者3例，尿崩者1例恢复正常，泌乳素增高者2例明显改善，垂体功能低下4例改善不明显。结论 垂体脓肿患者很少表现有感染症状，术前易误诊。对垂体所处部位囊性病变且影像学上有环形强化者应考虑到垂体脓肿可能。经单鼻孔蝶窦入路手术可获较佳疗效。 【关键词】垂体脓肿；诊断；手术治疗； Diagnosis and management of pituitary abscess（a report of 5 cases） 【Abstract】 Objective To investigate the clinical diagnosis and treatment of pituitary abscess. Methods A total of 5 patients with pituitary abscess were involved in this retrospective study. The medical history,clinical manifestation, imaging and endocrine findings, treatment and outcome of follow-up were analyzed. Results All the 5 cases had no 作者单位：550002 贵州省人民医院神经外科 通信作者：韩国强，电话：0851-5933152，Email:yhgzs01@163.com intracranial and systemic symptoms of infection.Headache and dizziness in 5 cases，visual disturbance in 3 cases，abnormal pituitary function in 4 cases, diabetes insipidus in 1 case. 5 cases underwent transsphenoidal microsurgery, In postoperative follow-up study there were recurrence in 1 case, vision improved in 3 cases, diabetes insipidus recovered to normal in 1 case, abnormal pituitary function returned to normal in 1 case. Prolactin level were significantly improved in 2 cases, hypopituitarism in 4 cases had no significant improvement. Conclusions Most patients with pituitary abscess had no infection-related symptoms, and the correct diagnosis is difficult before the operation. The cystic lesion with an annular reinforcement in imaging in pituitary region should be considered to the pituitary abscess. Transsphenoidal microsurgery can obtain satisfactory curative effect. 【Key words】Pituitary Abscess; Diagnosis; Microsursery; 垂体脓肿是一种少见的颅内感染性疾病，术前易误诊。自Simmonds于1914年报道了第1例垂体脓肿至今，英文文献累计报道约200余例[1]。我院于2008年3月~2012年2月共收治垂体脓肿患者5例，均经手术及术后病理证实，现报道如下。 1 材料与方法 1.1 一般资料 男性2例，女性3例，年龄34~69岁，平均年龄51.4岁。病程3月~2年，平均7.8月。 1.2 临床表现 5例患者均无颅内及全身感染病史，头痛头昏者5例，3例患者有视