發(fā)布時間：2018-05-18 03:33

  本文選題：垂體膿腫 + 病因　； 參考：《吉林大學》2015年碩士論文

【摘要】：目的：探討垂體膿腫的發(fā)病特點、臨床表現(xiàn)、影像學特征及治療方法，分析誤診原因，提高臨床診斷治療水平，提高治愈率。 方法：回顧性分析吉林大學白求恩第一醫(yī)院自2000年6月至2014年12月收治的垂體膿腫19例病例資料，對其發(fā)病特點、臨床及影像學表現(xiàn)、治療方法及預后情況進行總結。 結果：男性7例，女性12例；10例患者存在鞍區(qū)手術史、蝶竇炎、上頜竇炎、篩竇炎、額竇炎、中耳炎、肺炎等發(fā)病危險因子；出現(xiàn)頭痛16例（占84.2%）是最常見的癥狀；出現(xiàn)視力障礙者（包括視力下降、視物模糊、復視等）10例（52.6%），存在腺功能減退者（包括閉經2例、乏力2例、性欲減退4例、毛發(fā)脫落3例等）8例（42.1%），尿崩者6例（31.6%），有感染癥狀者（包括發(fā)熱、項強）4例（21.1%）；誤診為垂體腺瘤或復發(fā)垂體腺瘤或垂體腺瘤出血者12例（63.2%），顱咽管瘤2例，Rathke囊腫1例，生殖細胞瘤1例；19例僅有3例術前診斷為垂體膿腫，誤診率為84.2%；13例行經鼻蝶入路垂體膿腫清除術患者僅1例發(fā)生術后顱內感染，4例開顱手術的患者全部發(fā)生顱內感染，藥物保守治療治愈2例。 結論：垂體膿腫發(fā)病率低，誤診率高，中青年女性多發(fā)；垂體膿腫的發(fā)病因子中以各種副鼻竇炎最常見，經蝶手術史次之；頭痛和視力障礙是最常見的癥狀，，且術后可能很快恢復；中樞性尿崩和頑固的垂體功能低下出現(xiàn)較早，術后恢復較差；同一患者磁共振信號隨病程進展可以發(fā)生演變；經鼻蝶垂體膿腫清除術結合術后抗生素治療在絕大多數(shù)情況下是最適合的治療方案，但有時積極而合理的藥物治療也可能使一些垂體膿腫患者獲得治愈。
[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.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R651.1

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本文編號：1904200