目的 探讨不同类型Rathke囊肿的手术治疗方法及术后复发问题.方法 回顾性分析35例经病理证实的症状性Rathke囊肿病人,其中行内镜下经蝶手术20例,行常规开颅显微手术12例,行内镜下锁孔手术3例.结果 术后所有病人术前症状均改善或治愈.20例经蝶手术病例中,均为部分切除,术后出现短暂脑脊液漏3例,一过性尿崩2例.12例常规开颅手术病例中,全切除8例,部分切除4例,术后出现一过性尿崩4例.3例内镜锁孔手术病例均为部分切除,术后未出现并发症.随访35例,平均时间17.6个月,3例出现症状性复发并再次手术治疗.结论 应针对Rathke囊肿的部位和毗邻关系选择个体化手术入路,囊壁部分切除通常可取得满意疗效；对于有症状的复发病例,可再次手术治疗.%Objective To explore surgical methods for different types of Rathke cleft cysts (RCCs) and management of the recurrent problems. Methods Clinical data of 35 patients with symptomatic RCCs by pathological verification were analyzed retrospectively. The endoscopic transsphenoidal surgery was performed on 20 patients, conventional craniotomy microsurgery on 12 and endoscopic keyhole craniotomy on 3. Results The neurologic deficits of all the patients recovered or improved after surgery. The partial removal was achieved in 20 patients treated via transsphenoidal approach, and temporary cerebrospinal rhinorrhea occurred in 3 patients and transient diabetes insipidus in 2. The complete removal was performed on 8 and partial removal on 4 of 12 patients with conventional craniotomy and transient diabetes insipidus occurred in 4 patients postoperatively. There was no postoperative complication in 3 patients treated by endoscopic keyhole craniotomy. All the patients were followed up with a mean period of 17.6 months. The symptomatic recurrence was seen in 3 patients who underwent surgery again. Conclusions Individual surgical approach should be selected for patients with RCCs based on different locations and surrounding anatomical structures. Satisfactory surgical outcomes can be achieved by partial resection of the cyst wall. A repeated surgery can be performed on symptomatic recurrence.
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