目的 探讨症状性Rathke囊肿的临床特征及经鼻蝶入路神经内镜手术治疗的疗效.方法 回顾性分析2016年8月至2021年8月神经内镜手术治疗的53例症状性RCCs的临床资料.结果 头痛、头晕44例,视觉诱发电位异常43例,视力下降27例,视野缺损23例,垂体激素功能紊乱29例.MRI显示囊肿最大直径10~38 mm,平均(15.2±0.8)mm;其中≤15 mm有36例,>15 mm有17例;囊肿主体位于鞍内25例,鞍内-鞍上28例.囊肿全切除30例,大部分切除或仅行囊肿开窗引流23例.术后发生电解质紊乱25例,垂体功能低下14例,颅神经损伤7例,脑脊液鼻漏4例.出院后随访3~60个月,平均(13.5±5.6)个月;复发6例(11.3%),复发时间13~52个月,平均(21.5±4.9)月;2例再次手术治疗,4例随访观察.结论 症状性RCCs的临床表现多种多样且缺乏特异性,MRI是术前评估的主要方法.经鼻蝶入路神经内镜手术治疗的疗效良好.
Objective To investigate the clinical characteristics of symptomatic Rathke's cleft cysts(RCCs)and the outcomes of endoscopic endonasal transsphenoidal surgery(EETS)for RCCs.Methods The clinical data of 53 patients with symptomatic RCCs who underwent EETS form August 216 to August 2021 were analyzed retrospectively.Results Forty-four patients presented with headache and dizziness,43 with abnormal visual evoked potentials,27 with visual impairment,23 with visual field defect,and 29 with pituitary hormone dysfunction.MRI showed that the maximum diameter of cysts ranged from 10 to 38 mm,with an average of(15.2±0.8)mm.The cysts'diameter≤15 mm were found in 36 patients and>15 mm in 17 patients.The main bodies of cysts were located intrasellarly in 25 patients and intrasellar-suprasellarly in 28.The cysts were totally resected in 30 patients,and great partially or drainage in 23.Electrolyte disturbance occurred in 25 patients,hypopituitarism in 14,cranial nerve injury in 7 and cerebrospinal fluid rhinorrhea in 4 after operation.The patients were followed up for 3~60 months after discharge,with an average of(13.5±5.6)months.Six patients(11.3%)recurred,and the recurrence time was 13~52 months,with an average of(21.5±4.9)months.Two patients were re-operated and four were followed up.Conclusions The clinical manifestations of symptomatic RCCs are varied and lack of specificity.MRI is the main method of preoperative evaluation.The efficacy of EETS is good for patients with symptomatic RCCs.