经翼点入路鞍区肿瘤的手术并发症及相应对策  

Complications of surgery through pteriontal approach of sellar tumors and their prevention

作　　者：贾栋[1] 高国栋[1] 李永林[1] 赵振伟[1] 

机构地区：[1]第四军医大学唐都医院神经外科,陕西西安710038

出　　处：《现代肿瘤医学》2006年第9期1065-1067,共3页Journal of Modern Oncology

摘　　要：目的:探讨经翼点入路显微切除鞍区肿瘤常见并发症相关因素及预防方法。方法:回顾性分析140例鞍区肿瘤的临床资料。结果:垂体瘤64例(62.5%),全切42例(65.6%),次全切22例(34.4%),视神经功能改善56例(87.5%),内分泌症状改善40例(62.5%),垂体柄保留62例(96.8%)。鞍上脑膜瘤48例,全切42例(87.5%),次全切除6例(12.5%),视神经功能改善40例(83.3%),内分泌症状改善38例(79.1%),垂体柄保留47例(97.9%)。颅咽管瘤28例,全切23例(83.3%),次全切除5例(16.7%),视神经功能改善20例(71.4%),内分泌症状改善21例(75%),垂体柄保留24例(85.7%);主要并发症包括视力恶化(8.4%),尿崩(17.2%),电解质紊乱(11.2%),偏瘫(2.5%)等。手术死亡3例(2.1%)。结论:术前详细检查明确肿瘤性质及周围组织关系,熟悉鞍区解剖及熟练掌握显微外科技术是减少手术并发症的关键,术中须仔细分离肿瘤与正常组织,首先定位并辨认保护好视神经、垂体柄、颈内动脉、下丘脑的穿支供血动脉及外展神经。Objective：To explore the complications relate to the operation through pteriontal approach for resection sellar tumors and their preventive measures. Methods： The clinical data of 140 treated by microsurgical surgery with sellar tumors through pteriontal approach was analyzed retrospectively. Results： Of 64 patients with pituitary,42 patients received total resection of the tumors（65.6% ） and 22 patients subtotal （34.5%）, the function of optic nerve was improve in 56 patients （87.5%）, the endocrine symptom was improved in 40 patients （62.5%） , the pituitary stalks were preserved in 62 patients（96.8% ）. Of 48 patients with supersellar meningiomas, 42 patients received total resection of the tumors （87.5 % ） and 6 patients subtotal（ 12.5 % ）, the function of optic nerve was improved in 40 patients （ 83.3% ） , the endocrine symptom was improved in 38 patients （ 79.1% ）, the pituitary stalks were preserved in 47 patients（97.9% ）. Of 28 patients with craniopharyngiomas, 23 patients received total resection of the tumors （ 83.3 % ） and 5 patients subtotal（ 16.7 % ）, the function of optic nerve was improved in 20 patients （ 71.4% ）, the endocrine symptom was improved in 21 patients （ 75. 0% ） . the pituitary stalks were preserved in 24 patients （ 85.7% ）. The major complications included visual deterioration, dibates insipidus, electrolyte diaorder, hemiparesis, 3 died postoperatively. Conclusion： It is important to decrease the complications after sellar tumors that know well the relationship between sellar tumors and adjacent structures, have good microsurgical techniques during operation , must protect optic nerve, pituitary stalk and small arteries feeding hypothalamus.

关 键 词：鞍区肿瘤 并发症 显微技术 

分 类 号：R739.41[医药卫生—肿瘤]