急性垂体瘤卒中的临床特征、诊断及治疗方法：病例报告并文献复习

发布时间：2018-03-26 18:08

本文选题：急性垂体瘤卒中　切入点：临床症状　出处：《山东大学》2015年硕士论文

【摘要】：目的：报道急性垂体瘤卒中病例,总结急性垂体瘤卒中的临床特征,探讨其诊断及治疗方法。方法：回顾性分析本科室救治的急性垂体瘤卒中患者的临床资料,并结合文献进行复习总结。资料：44岁男性患者1位,头痛并视物模糊3日余,伴恶心、呕吐。干预措施：患者入院后立即给予适量氢化可的松进行激素替代治疗,同时完善实验室(入院系列、垂体系列激素)和影像学辅助检查(颅脑CT平扫、垂体MRI平扫+强化),控制体温,纠正水、电解质紊乱。初步纠正病人身体一般情况后,于入院后第3天在全身麻醉下进行经鼻蝶入路手术减压。术后患者长期应用口服激素替代治疗。结果：患者术后常规病理检查结果显示垂体瘤卒中。术后一般状况恢复好,视力及垂体功能显著改善。结论：急性垂体瘤卒中是指临床症状在发病后24h内达到高峰的垂体瘤卒中。垂体腺瘤人群中急性垂体瘤卒中的发生率约为1.6%-10%,40～50岁是急性垂体瘤卒中的发病高峰年龄段。急性垂体瘤卒中是由垂体腺瘤瘤内突发出血或缺血梗塞,甚至是缺血梗死后继发出血,然后累及鞍旁组织所导致的少见的临床综合征,临床上垂体瘤卒中病人发病一段时间后病情可以再次爆发性进展,这可能是由于缺血梗死后继发出血所致,应该引起足够重视。急性垂体瘤卒中的症状主要包括突然发作的头痛,恶心、呕吐,视力下降,视野缺陷,眼肌麻痹,甚至意识障碍以及部分或全垂体功能减退等。除此之外,急性垂体瘤卒中还可以引起蛛网膜下腔出血或全身其它系统的并发症,是一种临床危重症。尽管如此,急性垂体瘤卒中经过及时得当的处置是可以获得痊愈的。垂体大腺瘤或巨大腺瘤更容易发生出血,从而引起垂体瘤卒中,无功能腺瘤早期难以被发现,更容易发展为大腺瘤或巨大腺瘤,从而增加了发生卒中出血的风险。垂体瘤卒中的发病急性期最为实用的影像学辅助检查是CT扫描,诊断急性垂体瘤卒中最理想的影像学辅助检查手段是垂体MRI检查。对于急性垂体瘤卒中患者,尤其是对视力急剧下降或存在意识障碍的患者,纠正一般情况后尽快手术减压是术后视力恢复和保护垂体功能的前提条件,急性垂体瘤卒中发病1周以内进行手术治疗的病人比发病1周后进行手术的病人具有更高的视力改善比率,急性垂体瘤卒中患者手术减压时的首选入路是经鼻蝶入路。在围手术期特别是手术前进行早期激素替代治疗和及时控制中枢性高热,纠正水、电解质平衡紊乱在患者的预后中发挥着重要作用。对于急性垂体瘤卒中患者的治疗是终生性的,超过一半的患者需要一种或多种垂体激素进行终生激素替代治疗。
[Abstract]:Objective: to report the cases of acute pituitary apoplexy, summarize the clinical features of acute pituitary apoplexy, and discuss its diagnosis and treatment. Methods: the clinical data of acute pituitary apoplexy treated in our department were analyzed retrospectively. Data: 1 male, 44 years old, had headache and blurred vision for more than 3 days, accompanied by nausea and vomiting. Intervention measures: patients were given appropriate amount of hydrocortisone for hormone replacement therapy immediately after admission. At the same time, the laboratory (admission series, pituitary hormone series) and imaging auxiliary examination (craniocerebral CT plain scan, pituitary MRI plain scan enhancement, body temperature control, water and electrolyte disturbance correction) and imaging auxiliary examination (brain CT plain scan, pituitary MRI plain scan) were improved. On the third day after admission, the patients were decompressed by transsphenoidal approach under general anesthesia. The patients were treated with oral hormone replacement therapy for a long time. Conclusion: acute pituitary apoplexy refers to pituitary adenoma apoplexy whose clinical symptoms peak within 24 hours after onset. The incidence of acute pituitary apoplexy in pituitary adenoma population is about 1.6-104050 years old is acute. Acute pituitary apoplexy is caused by sudden hemorrhage or ischemic infarction in pituitary adenoma. Even the rare clinical syndrome caused by secondary bleeding after ischemic infarction and then involvement of the parasellar tissue, may occur again after the onset of pituitary adenoma stroke for a period of time. This may be due to secondary bleeding after ischemic infarction, and should be taken into account. Symptoms of acute pituitary adenoma stroke include sudden onset of headache, nausea, vomiting, impaired vision, visual field defect, ophthalmoplegia. In addition, acute pituitary apoplexy can cause subarachnoid hemorrhage or complications of other systemic systems. Acute pituitary apoplexy can be cured with timely and proper treatment. Large pituitary adenomas or giant adenomas are more likely to bleed, leading to pituitary apoplexy, which is difficult to detect in the early stages of nonfunctioning adenomas. It is more likely to develop into macroadenomas or giant adenomas, which increases the risk of bleeding from stroke. The most useful imaging aids for pituitary apoplexy are CT scans. The most ideal imaging adjuvant for the diagnosis of acute pituitary apoplexy is pituitary MRI. Surgical decompression as soon as possible after correcting the general situation is a prerequisite for the recovery of visual acuity and the protection of pituitary function. Patients with acute pituitary apoplexy who underwent surgery less than one week after the onset of acute pituitary adenoma had a higher rate of visual improvement than those who underwent surgery one week after the onset of acute pituitary adenoma. Transsphenoidal approach is the preferred approach for patients with acute pituitary adenoma apoplexy. Early hormone replacement therapy and timely control of central hyperthermia are performed during the perioperative period, especially before surgery, to correct water. Electrolyte imbalance plays an important role in the prognosis of patients. The treatment of acute pituitary apoplexy is life-long, and more than half of the patients need one or more pituitary hormone for life-long hormone replacement therapy.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R736.4

【相似文献】