垂体脓肿的临床诊断及治疗

发布时间：2018-05-18 03:33

本文选题：垂体脓肿 + 病因　；参考：《吉林大学》2015年硕士论文

【摘要】：目的：探讨垂体脓肿的发病特点、临床表现、影像学特征及治疗方法，分析误诊原因，提高临床诊断治疗水平，提高治愈率。方法：回顾性分析吉林大学白求恩第一医院自2000年6月至2014年12月收治的垂体脓肿19例病例资料，对其发病特点、临床及影像学表现、治疗方法及预后情况进行总结。结果：男性7例，女性12例；10例患者存在鞍区手术史、蝶窦炎、上颌窦炎、筛窦炎、额窦炎、中耳炎、肺炎等发病危险因子；出现头痛16例（占84.2%）是最常见的症状；出现视力障碍者（包括视力下降、视物模糊、复视等）10例（52.6%），存在腺功能减退者（包括闭经2例、乏力2例、性欲减退4例、毛发脱落3例等）8例（42.1%），尿崩者6例（31.6%），有感染症状者（包括发热、项强）4例（21.1%）；误诊为垂体腺瘤或复发垂体腺瘤或垂体腺瘤出血者12例（63.2%），颅咽管瘤2例，Rathke囊肿1例，生殖细胞瘤1例；19例仅有3例术前诊断为垂体脓肿，误诊率为84.2%；13例行经鼻蝶入路垂体脓肿清除术患者仅1例发生术后颅内感染，4例开颅手术的患者全部发生颅内感染，药物保守治疗治愈2例。结论：垂体脓肿发病率低，误诊率高，中青年女性多发；垂体脓肿的发病因子中以各种副鼻窦炎最常见，经蝶手术史次之；头痛和视力障碍是最常见的症状，，且术后可能很快恢复；中枢性尿崩和顽固的垂体功能低下出现较早，术后恢复较差；同一患者磁共振信号随病程进展可以发生演变；经鼻蝶垂体脓肿清除术结合术后抗生素治疗在绝大多数情况下是最适合的治疗方案，但有时积极而合理的药物治疗也可能使一些垂体脓肿患者获得治愈。
[Abstract]:Objective: to investigate the characteristics, clinical manifestations, imaging features and treatment of pituitary abscess, analyze the causes of misdiagnosis, improve the level of clinical diagnosis and treatment, and improve the cure rate. Methods: the data of 19 cases of pituitary abscess admitted from June 2000 to December 2014 in Bai Qiuen first Hospital of Jilin University were retrospectively analyzed. Results: there were 7 males and 12 females with history of operation in Sellar region, sphenoid sinusitis, maxillary sinusitis, ethmoiditis, frontal sinusitis, otitis media, pneumonia and other risk factors, headache in 16 cases (84.2%) was the most common symptom. The patients with visual impairment (including vision loss, blurred vision, diplopia, etc., 10 cases) had hypoglandular function (including 2 cases of amenorrhea, 2 cases of asthenia and 4 cases of decreased libido). Hair loss was found in 3 cases (42.1%), urinary collapse in 6 cases (31.6%), symptoms of infection (including fever, 4 cases), misdiagnosis of pituitary adenoma or recurrent pituitary adenoma or hemorrhage of pituitary adenoma (12 cases), craniopharyngioma (2 cases) Rathke's cyst (1 case), hair loss (3 cases), urine collapse (6 cases), infection symptom (including fever, 4 cases), hemorrhage of pituitary adenoma or recurrent pituitary adenoma (12 cases), craniopharyngioma (2 cases). 19 cases of germ cell tumor were diagnosed as pituitary abscess before operation. The misdiagnosis rate was 84.2%. In 13 cases of pituitary abscess clearance via transsphenoidal approach, only 1 case had postoperative intracranial infection and 4 cases had craniotomy all developed intracranial infection. 2 cases were cured by conservative drug therapy. Conclusion: the incidence of pituitary abscess is low, the rate of misdiagnosis is high, the incidence of pituitary abscess is the most common among the factors of pituitary abscess, the history of transsphenoidal surgery is the second, headache and vision disorder are the most common symptoms. The central urinary avalanche and the stubborn hypophysis appeared earlier, but the recovery was poor after operation, and the MRI signal of the same patient could evolve with the course of the disease. Transsphenoidal pituitary abscess removal combined with postoperative antibiotic therapy is the most suitable treatment in most cases, but sometimes active and reasonable drug therapy may also cure some patients with pituitary abscess.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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