Japanese
English
- 有料閲覧
- Abstract 文献概要
- 1ページ目 Look Inside
- 参考文献 Reference
Ⅰ.はじめに
ラトケ囊胞は通常は無症状であるが,トルコ鞍内から鞍上部に進展し周囲組織を圧迫するようになると症候性となり9),多くは下垂体機能低下を来すが3,4),視機能障害も認められる.非腫瘍性病変であり,治療法は経蝶形骨洞手術(transsphenoidal surgery:TSS)による囊胞開窓術とドレナージで十分とされる.しかしmass effectが解除されても,視機能およびプロラクチン値改善率は良好なものの,他の前葉ホルモン値や尿崩症(diabetes insipidus:DI)の改善は困難とされ1-3),ホルモン補充療法を必要とする場合が多い.
近年,内視鏡下経蝶形骨洞手術(endoscopic TSS:eTSS)は顕微鏡下手術に比し,新たな内分泌障害の発生率が低いという結果が得られている6).顕微鏡下手術では光軸の都合上,正常下垂体の存在するトルコ鞍腹側での開窓となり,下垂体前葉に割が及ぶため,内分泌機能の改善が得がたいのではないかと推測される.一方,内視鏡下手術はある程度任意の角度でのアプローチが可能であるため,顕微鏡下手術よりも正常下垂体を避けた囊胞の開窓が行えるためではないかと推察される(Fig.1).今回われわれは,当科におけるeTSS導入後のラトケ囊胞の長期的な内分泌学的予後の改善の有無について検討した.
Pituitary dysfunction, such as panhypopituitarism or diabetes insipidus(DI), is often found in patients with Rathke's cleft cyst. Patients were treated with transsphenoidal microscopic surgery;however, pituitary dysfunction did not usually recover. Recently, endoscopic transsphenoidal surgery(eTSS)has enabled minimally invasive surgery for patients with Rathke's cleft cyst.
In this study, we analyzed 22 consecutive patients with Rathke's cleft cyst who underwent eTSS to determine if pituitary dysfunction recovered. The follow-up period ranged from 3 months to 19.25 years(mean, 4.75 years). Preoperative endocrinological evaluation showed impaired secretion of adrenocorticotropic hormone(ACTH)in 4 cases(18.2%), thyroid-stimulating hormone(TSH)in 2 cases(9.1%), hyperprolactinemia in 5 cases(22.7%), growth hormone(GH)in 9 cases(40.9%), and luteinizing hormone(LH)/follicle-stimulating hormone(FSH)in 11 cases(50%). In addition, preoperative DI was found in 2 cases(9.1%). We planned the site of fenestration for the cyst wall using preoperative sagittal magnetic resonance imaging. As a result, the recovery rate for ACTH, GH, and TSH secretion was 25%, 33.3%, and 50%, respectively. On the other hand, two patients with DI and other hormonal deficiencies did not recover pituitary function because of severe inflammation.
Pituitary function might be preserved with minimally invasive surgery for Rathke's cleft cyst with mild inflammation.
Copyright © 2018, Igaku-Shoin Ltd. All rights reserved.