神经内镜扩大经鼻入路治疗颅咽管瘤的临床分析  

Clinical analysis of extended endoscopic endonasal approach for craniopharyngioma treatment

作　　者：阮伦亮 靳凯[1] 谭松[1] 王福超[1] 牟家民 王晓澍[1] 霍钢[1] 郑履平[1] 孙晓川[1] 杨刚[1] 

机构地区：[1]重庆医科大学附属第一医院神经外科,400016

出　　处：《中华神经外科杂志》2017年第5期470-474,共5页Chinese Journal of Neurosurgery

基　　金：国家临床重点专科建设项目（财社[2011]170号）;重庆市自然科学基金（CSTC2013jcyjA10079）

摘　　要：目的探讨采用神经内镜扩大经鼻入路手术治疗颅咽管瘤的疗效和安全性。方法回顾性分析2014年11月至2016年5月重庆医科大学附属第一医院神经外科收治的32例颅咽管瘤患者的临床资料。所有病例均行神经内镜扩大经鼻入路手术治疗。分析肿瘤的切除程度，患者的视力、视野改善情况，内分泌功能变化以及手术并发症。结果全切除22例（69％，22／32），近全切除8例（25％，8／32），次全切除2例（6％，2／32）。存在视力、视野损害的28例患者中，24例（86％，24／28）术后视力、视野有不同程度的改善。术后腺垂体功能减退加重或出现新发腺垂体功能减退17例（53％，17／323，新发尿崩症12例（48％，12／25）。13例（41％）术后出现嗅觉减退，3例（9％）出现严重记忆减退，发生脑脊液漏伴严重颅内感染1例（3％），脑干出血1例（3％）。随访时间为4～22个月。随访期内复查MRI均未见肿瘤复发，1例死亡。结论采用神经内镜扩大经鼻入路手术治疗颅咽管瘤安全、有效，全切除率高；但仍可能导致或加重下丘脑一垂体轴功能的损害，因此手术治疗过程中对于内分泌功能的保护仍需持续关注。Objective To evaluate the efficacy and safety of extended endoscopic endonasal approach for resection of craniopharyngiomas. Methods The clinical data of 32 patients with craniopharyngiomas undergoing extended endoscopic endonasal surgery at Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University between November 2014 and May 2016 were analyzed retrospectively. The visual improvement, extent of resection and surgical complications were evaluated. Results The gross total resection （GTR） rate was 69% （22/32）, near-total resection （ 〉 95% of tumor removed ） was 25% （8/32）, and subtotal resection （ ≥ 80% of tumor removed） was 6% （2/32）. Overall, 28 patients presented with visual impairment. In 86% （24 patients） of them, visions were improved or even recovered to normal following surgery. Worsening of the anterior pituitary function was reported in 53% （17 patients） of all, and there were 12 new cases （48% of 25 ） of postoperative diabetes insipidus. Thirteen （41%） patients had hyposmia and 3 （9%） patients developed severe hypomnesia after surgery. CSF leakage and secondary meningitis occurred in 1 （ 3% ） patient postoperatively. One （ 3% ） patient had brainstem hemorrhage ＇after surgery. The follow-up lasted 4 - 22 months. No tumor recurrence was identified by MRI examination, and one patient died. Conclusions The extended endoscopic endonasal approach for craniopharyngiomas seems generally effective and safe with high GTR rate, which however could also cause damage of hypothalamic-pituitary axis. Thus, continuous attention should be paid to preservation of the endocrine function during surgical management of eraniopharyngioma.

关 键 词：颅咽管瘤 神经内镜 神经外科手术 治疗结果 扩大经鼻入路 

分 类 号：R739.41[医药卫生—肿瘤]