儿童颅咽管瘤的显微手术治疗体会  

Microsurgical experience with pediatric craniopharyngiomas

作　　者：王国良[1] 李天栋[1] 高寒[1] 公方和[1] 张小鹏[1] 

机构地区：[1]广州军区广州总医院神经外科,广州510010

出　　处：《广东医学》2015年第17期2625-2628,共4页Guangdong Medical Journal

摘　　要：目的探讨儿童颅咽管瘤的手术要点及其围手术期处理。方法回顾性分析32例行显微手术治疗的颅咽管瘤患儿的临床资料,总结治疗过程中的体会。结果肿瘤全切除20例,次全切除10例,大部切除2例。其中经翼点入路手术的14例患儿肿瘤全切除7例,次全切除6例,大部切除1例;经额下-纵裂入路手术的18例患儿肿瘤全切除13例,次全切除4例,大部切除1例。术后恢复良好18例,改善12例,死亡2例。术后最常见的并发症为水、电解质代谢紊乱。术后获随访的18例中,肿瘤复发6例,予以再次手术后病情稳定。结论全切除肿瘤是决定颅咽管瘤患儿预后的关键因素,良好的显露是达到肿瘤全切除并保护下丘脑的重要条件,经额下-纵裂入路可提供较好的肿瘤显露,围手术期水、电解质代谢紊乱的治疗和激素补充至关重要。Objective To explore the key elements of microsurgical procedure and peri- operative management of pediatric craniopharyngiomas. Methods The clinical data of 32 cases of pediatric craniopharyngiomas were retrospectively analyzed for microsurgical strategy and therapeutic results. Results Total resection of tumor was achieved in 20 cases,subtotal in 10 cases and partial in 2 cases. Pterional approach was applied in 14 cases with 7 cases of total resection,6 cases of subtotal resection and 1 case of partial resection. Transsubfrontal- translongitudinal approach was applied in 18 cases,with 13 cases of total resection,4 cases of subtotal and 1 case of partial resection. Eighteen cases had good recovery,12 cases had improved condition and 2 cases died after surgery. The most common complication was disorders of water and electrolyte metabolism. Of the 18 followed- up cases,6 cases presented tumor recurrence,and were in stable condition after second operation. Conclusion Total removal of tumor with microsurgical technique is the key factor that determines the prognosis of pediatric cyraniopharyngiomas. A good exposure is an important factor to achieve total excision of the tumor and sparing of the hypothalamus,and transsubfrontal- translongitudinal approach can help with exposure of craniopharyngiomas. Management of water and electrolyte disorders and hormone supplement during peri- operative period is also very important.

关 键 词：颅咽管瘤 显微外科手术 经额下-纵裂入路 经翼点入路 儿童 

分 类 号：R739.41[医药卫生—肿瘤]