摘要
目的:探讨垂体脓肿的临床特点及手术疗效分析。方法:回顾性分析2000年9月至2019年9月北京大学第三医院神经外科收治的14例垂体脓肿患者的临床资料。所有患者均行经鼻蝶窦入路脓肿清除术,术中均留取脓液和脓壁组织以备病原学检查,术后给予抗感染治疗。术后2周复查头颅MRI和抽血行实验室检查。出院后定期行临床和影像学随访,判断患者的临床症状改善和脓肿复发情况。结果:14例患者的临床症状主要有头痛(13/14)、视力下降(10/14)、垂体功能减退(8/14)、尿崩(6/14);8例有感染史,其中7例为鼻窦炎。头颅CT和MRI均可见鞍区或鞍区及鞍上病变,MRI平扫呈中心囊性改变(14/14),增强扫描可见环形强化(11/14)或不规则增强影(3/14)。术后无一例死亡或发生感染。术后2周复查,所有患者的脓肿均消失。14例患者的脓液涂片均可见大量中性粒细胞、浆细胞、淋巴细胞或坏死组织;其中3例检出致病菌,2例为革兰阳性菌,1例为革兰阴性杆菌。14例患者的随访时间为(4.5±1.2)个月(3~6个月)。随访期间,所有患者的体温正常;术前存在头痛、视力下降的患者症状均改善;存在垂体功能减退的8例患者中,7例好转,1例继续予以药物替代治疗;存在尿崩症的6例患者中,4例恢复正常,2例未恢复,但尿量较术前减少。至末次随访,14例患者复查鞍区增强MRI,均未见脓肿复发。结论:垂体脓肿的临床特点缺乏特异性,易被误诊;当患者有感染史、存在尿崩症或垂体功能减退,影像学提示鞍区有囊性病变,则考虑垂体脓肿的可能。采用经鼻蝶窦入路脓肿清除术和术后合理的抗感染治疗,患者预后良好。
Objective To explore the diagnosis and surgical treatment outcome of pituitary abscess.Methods The clinical data of 14 cases of pituitary abscess admitted to Department of Neurosurgery,Peking University Third Hospital from September 2000 to September 2019 were analyzed retrospectively in this study.All patients underwent abscess debridement via endonasal transsphenoidal approach.The pus and tissue of pus wall were collected during operation for pathogenic examination,and anti-infection treatment was administered post operation.At 2 weeks after operation,the head MRI and routine blood test were performed.All patients received regular clinical and imaging follow-up to explore the improvement of clinical symptoms and recurrence of abscess.Results The main clinical symptoms of 14 patients were headache(13/14),vision decline(10/14),hypopituitarism(8/14),diabetes insipidus(6/14).In this series,8 patients had the history of infection and 7 of them had sinusitis.The lesions of sellar region or lesions of sellar region and suprasellar region were revealed by both CT and MRI.The central cystic changes were observed on MRI(14/14),and ring enhancement(11/14)or irregular enhancement(3/14)was shown on enhanced MRI.A total of 14 patients were reviewed 2 weeks after operation,and the abscess disappeared.There was no death or infection.A large number of neutrophils,plasma cells,lymphocytes or necrotic tissues were found in the pus smear of 14 patients.Pathogenic bacteria were detected in 3 cases including Gram-positive bacteria in 2 cases and Gram-negative bacteria in 1 case.The follow-up time of 14 patients was 4.5±1.2 months(3-6 months).During follow-up,the body temperatures of all patients were normal.Preoperative headache and declined vision were improved.Out of 8 patients with hypopituitarism,7 recovered obviously and only 1 patient still underwent drug replacement treatment.Out of 6 patients with diabetes insipidus,4 recovered completely and the urine volumes of the remaining 2 patients were reduced significantly.At the latest follow-up,no recurrence of abscess was reported based on enhanced MRI of sellar region.Conclusions The pituitary abscess is nonspecific in terms of clinical features and thus easy to be misdiagnosed.When the patient has a history of infection,diabetes insipidus or hypopituitarism,and medical imaging suggests that there is cystic lesion in the sellar area,the possibility of pituitary abscess should be considered.The outcome of pituitary abscess seems good following endonasal transsphenoidal operation and reasonable postoperative anti-infection treatment.
作者
林国中
杨军
王振宇
谢京城
马长城
孙建军
于涛
陈素华
尹晓亮
于国强
Lin Guozhong;Yang Jun;Wang Zhenyu;Xie Jingcheng;Ma Changcheng;Sun Jianjun;Yu Tao;Chen Suhua;Yin Xiaoliang;Yu Guoqiang(Department of Neurosurgery,Peking University Third Hospital,Beijing 100191,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2020年第7期717-721,共5页
Chinese Journal of Neurosurgery
基金
北京大学临床科学家计划专项(BMU2019LCKXJ007)
北京大学第三医院临床重点项目(BYSY2018060)
首都临床特色应用研究(Z161100000516109)。
关键词
脓肿
垂体
诊断
神经外科手术
治疗结果
Pituitary
Abscess
Diagnosis
Neurosurgical procedures
Treatment outcome
