[1]王国鼎,高大宽,党俊涛.经鼻内镜手术治疗鞍区Rathke囊肿临床研究[J].陕西医学杂志,2022,51(10):1210-1214,1218.[doi:DOI:10.3969/j.issn.1000-7377.2022.10.008]
　WANG Guoding,GAO Dakuan,DANG Juntao.Clinical study of transnasal endoscopic surgery for Rathke's cleft cyst in sellar region[J].,2022,51(10):1210-1214,1218.[doi:DOI:10.3969/j.issn.1000-7377.2022.10.008]
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经鼻内镜手术治疗鞍区Rathke囊肿临床研究
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
51
期数:
2022年10期
页码:
1210-1214,1218
栏目:
临床研究
出版日期:
2022-10-05

文章信息/Info

Title:
Clinical study of transnasal endoscopic surgery for Rathke's cleft cyst in sellar region
作者:
王国鼎1; 高大宽2; 党俊涛3
(1.空军军医大学基础医学院临床医学系,陕西 西安 710032; 2.空军军医大学西京医院神经外科,陕西 西安 710032; 3.渭南市中心医院神经外科,陕西 渭南 714000)
Author(s):
WANG Guoding; GAO Dakuan; DANG Juntao
(Department of Clinical Medicine,Basic Medical College,Air Force Medical University,Xi'an 710032,China)
关键词:
Rathke囊肿;  经鼻内镜手术;  脑脊液漏;  颅底重建;  囊肿引流;  囊壁切除
Keywords:
Rathke's cleft cyst;  Transnasal endoscopic surgery;  Cerebrospinal fluid leakage;  Skull base reconstruction;  Cyst drainage;  Cyst wall resection
分类号:
R 739.41
DOI:
DOI:10.3969/j.issn.1000-7377.2022.10.008
文献标志码:
A
摘要:
目的:总结鞍区Rathke囊肿的临床特点和经鼻内镜手术治疗的临床技巧和疗效。方法:回顾性分析经鼻内镜手术治疗的46例鞍区症状性Rathke囊肿患者的临床资料,总结分析其疗效、并发症和手术优越性。其中38例行单鼻孔入路,8例行双鼻孔入路,观察组采用囊肿引流29例,采用囊液引流后囊壁部分切除17例作为对照组,依据不同手术进行颅底多层重建。 结果:所有病例随访1～7年,对不同手术方式组临床资料进行比较。所有病例头痛症状缓解24(96.2%)例,视力改善12(92.3%)例,内分泌症状缓解26(92.9%)例; 两组间比较无统计学差异(均P>0.05),术中出现4例(8.7%)脑脊液漏,不同入路组间比较有统计学差异(P<0.05); 3例出现嗅觉减退,1例出现垂体功能低下,1例在术后3年复发,给予临床观察,随访无变化,组间比较无统计学差异(均P>0.05); 所有病例术后未见脑脊液漏的发生。 结论:经鼻内镜治疗鞍区症状性Rathke囊肿,能够有效缓解症状,疗效确切,临床应用前景较好。
Abstract:
Objective:To summarize the clinical characteristics of Rathke's cleft cyst in sellar region and the clinical skills and efficacy of transnasal endoscopic surgery.Methods:The clinical data of 46 patients with symptomatic Rathke's cleft cyst in sallar region treated by transnasal endoscopic surgery were analyzed retrospectively,and the efficacy,complications and surgical advantages were summarized and analyzed.Among them,38 cases were treated by single nostril approach and 8 cases by binostril approach.In the observation group,29 cases were treated with cyst drainage,and 17 cases were treated with partial resection of the cyst wall with drainage of the intracystic contents was performed as the control group.The multilayered reconstruction technique was used according to different procedures.Results:All patients were followed up for 1 to 7 years,and the clinical data of different surgical methods were compared.Headache symptoms were relieved in 24 cases(96.2%),visual acuity was improved in 12 cases(92.3%),endocrine symptom relief in 26 cases(92.9%),and there was no significant difference between the two groups(all P>0.05).The cerebrospinal fluid leakage occurred in 4 cases(8.7%)during the operation,and there was statistical significance in different approaches(P<0.05).The hyposmia occurred in 3 cases and hypopituitarism occurred in 1 case after the operation.One case had recurrence 3 years after operation,clinical observation was given,and no change was observed during follow-up,and the differences were not statistically significant(all P>0.05).There was no cerebrospinal fluid leakage occurred in all cases perioperation.Conclusion:Transnasal endoscopic surgery in the treatment of symptomatic Rathke's cleft cyst in sallar region can effectively relieve symptoms,with the advantages of low complications and less endocrine disruption. It has a good prospect of clinical application.

参考文献/References:

[1] Babu R,Back AG,Komisarow JM,et al.Symptomatic Rathke's cleft cyst with a co-existing pituitary tumor; Brief review of the literature[J].Asian J Neurosurg,2013,8(4):183-187.
[2] Trifanescu R,Ansorge O,Wass JA,et al.Rathke's cleft cysts[J].Clin Endocrinol(Oxf),2012,76(2):1511-1560.
[3] Ozoner B,Aydin S,Akgun MY,et al.Predictive factors for rathke's cleft cyst consistency[J].World Neurosurg,2019,128:e522-e530.
[4] Park M,Lee SK,Choi J,et al.Differentiation between cystic pituitary adenomas and rathke cleft cysts:A diagnostic model using MRI[J].AJNR Am J Neuroradiol,2015,36(10):1866-1873.
[5] Kilday JP,Laughlin S,Urbach S,et al.Diabetes insipidus in pediatric germinomas of the suprasellar region:Characteristic features and significance of the pituitary bright spot[J].J Neurooncol,2015,121(1):167-175.
[6] Schreckinger M,Szerlip N,Mittal S.Diabetes insipidus following resection of pituitary tumors[J].Clin Neurol Neurosurg,2013,115(2):121-126.
[7] Montaser AS,Catalino MP,Laws ER.Professor Rathke's gift to neurosurgery:The cyst,its diagnosis,surgical management,and outcomes[J].Pituitary,2021,24(5):787-796.
[8] Madhok R,Prevedello DM,Gardner P,et al.Endoscopic endonasal resection of Rathke cleft cysts:Clinical outcomes and surgical nuances[J].J Neurosurg,2010,112(6):1333-1339.
[9] Altuwaijri N,Cote DJ,Lamba N,et al.Headache resolution after rathke cleft cyst resection:A meta-analysis[J].World Neurosurg,2018,111:e764-e772.
[10] Truong LUF,Bazin C,Gomis P,et al.Surgery versus conservative care for Rathke's cleft cyst[J].Neurochirurgie,2021,67(2):104-111.
[11] Amhaz HH,Chamoun RB,Waguespack SG,et al.Spontaneous involution of Rathke cleft cysts:Is it rare or just underreported[J].J Neurosurg,2010,112(6):1327-1332.
[12] Salle L,Teissier MP,Mas R,et al.Spontaneous involution of a Rathke cleft cyst[J].Ann Endocrinol(Paris),2021,82(6):626-628.
[13] Higgins DM,Vangompel JJ,Nippoldt TB,et al.Symptomatic rathke cleft cysts:Extent of resection and surgical complications[J].Neurosurg Focus,2011,31(1):e2.
[14] Potts MB,Jahangiri A,Lamborn KR,et al.Suprasellar rathke cleft cysts:Clinical presentation and treatment outcomes[J].Neurosurgery,2011,69(5):1058-1068.
[15] Lu VM,Ravindran K,Perry A,et al.Recurrence of Rathke's cleft cysts based on gross total resection of cyst wall:A meta-analysis[J].Neurosurg Rev,2020,43(3):957-966.
[16] Mendelson ZS,Husain Q,Elmoursi S,et al.Rathke's cleft cyst recurrence after transsphenoidal surgery:A meta-analysis of 1151 cases[J].J Clin Neurosci,2014,21(3):378-385.
[17] Chotai S,Liu Y,Pan J,et al.Characteristics of Rathke's cleft cyst based on cyst location with a primary focus on recurrence after resection[J].J Neurosurg,2015,122(6):1380-1389.
[18] Limb R,King J.Relationship between recurrence rates of rathke's cleft cysts and surgical approaches to sellar reconstruction[J].J Neurol Surg B Skull Base,2021,82(Suppl 3):e105-e111.
[19] 谢 军,曾海燕,严亿军,等.经鼻内镜和显微镜经鼻蝶入路手术治疗垂体腺瘤卒中临床对比研究[J].陕西医学杂志,2019,48(11):1532-1534.
[20] Solari D,Cavallo LM,Somma T,et al.Endoscopic endonasal approach in the management of rathke's cleft cysts[J].PLoS One,2015,10(10):e0139609.
[21] 张亚飞,刘永建,陈海峰.经蝶窦入路显微切除垂体Rathke囊肿24例报告[J].陕西医学杂志,2016,45(5):543-544.

备注/Memo

备注/Memo:
基金项目:国家自然科学基金资助项目(81971227); 陕西省自然科学基金资助项目(2018ZDXM-SF-086)
更新日期/Last Update: 2022-10-07