摘要 目的：探讨垂体脓肿的诊断和经蝶窦显微手术治疗。方法：经蝶窦显微手术证实为垂体脓肿7例，3例术前诊断为垂体脓肿，4例诊断为其它鞍区病变。男性5例，女性2例，平均年龄38.8岁，平均病程2.3年。临床症状尿崩症5例，垂体功能低下4例，头痛3例，视力视野障碍2例，动眼神经麻痹1例。手术中彻底清除脓肿，放置碘仿纱条引流。结果：随诊3个月～6年，影像学检查脓肿征象均消失。3例头痛、2例视神经功能障碍术后缓解；3例尿崩症、2例垂体功能低下改善，1例术后2年复发。结论：若鞍区病变不大，但引起较严重的蝶鞍骨质破坏，表现为尿崩症和垂体功能低下时，应首先考虑垂体脓肿。及时手术探查，彻底清除脓肿和术后使用抗生素是治疗垂体脓肿的关键。

Abstract Objective: To discuss the diagnosis and transsephenoid microsurgery of pituitary abscess. Method:Seven patients with pituitary abscesses were proved by transsphenoidal microsurgery,though four of them were diagnosed as pituitary neoplasm preoperatively. 5 patients were male,2 female. The average age is 38.8 year-old. Duration of symptoms were 2.3 years in average. Preoperatively,diabetes insipidus was present in 5 patients,hypopituitarism in 4,headache in 3,visual interference in 2,and oculomotor nerve palsy in 1.Pituitary abscess were removed and drainaged completely by transsphenoid microsurgery. Results:After operation pituitary abscess of all paitents were confirmed to disappeared by MRI.Headache in 2 patients and visual interference in 2 patients were resoluted. Polyuria in 3 of 5 patients and hypopituitarism in 2 of 4 patients were improved after operation. Conclusion:Pituitary abscess should be considered when patients presented diabetes insipidus,hypopituitarism,sella bone erosion and sella neoplasm similar to a cyst tumor in CT or MRI. Transsphenoid microsurgery to drainage abscess with use of antibiotic is the key of treatment for pituitary abscess.

     Key words Pituitary neoplasm Abscess Diagnosis Microsurgery

垂体脓肿非常少见 ......