显微镜下经鼻蝶入路切除鞍内鞍上型颅咽管瘤的疗效分析  

Efficacy analysis of microsurgery for intra-suprasellar craniopharyngioma by endonasal transsphenoidal approach

作　　者：杨齐全 李松[1] 张银[1] 米香[1] 胡锦涛 段炼[1] 沈如飞[1] 杨辉[1] Yang Qiquan Li Song Zhang Yin Mi Xiang Hu Jintao Duan Lian Shen Rufei Yang Hui(Department ofNeurosurgery, Xinqiao Hospital Affiliated to the Third Military Medical University, Chongqing 400037, Chin)

机构地区：[1]第三军医大学新桥医院神经外科,重庆400037

出　　处：《中国微侵袭神经外科杂志》2017年第9期396-399,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：第三军医大学第二附属医院临床新技术项目资助(编号:2015L034)

摘　　要：目的探讨显微镜辅助下经鼻蝶手术入路切除鞍内鞍上型颅咽管瘤的疗效。方法回顾性分析10例鞍内鞍上型颅咽管瘤病人的临床资料,其中未成年病人4例,成年病人6例,均行经鼻蝶入路显微手术切除肿瘤。并比较手术前后病人临床症状和激素水平变化情况。结果肿瘤全切除8例,次全切2例,所有病人垂体柄完整保留。2例次全切除病人,术后行伽玛刀治疗1例,再次经鼻蝶手术1例。术后1个月因电解质紊乱死亡1例,1例随访4个月后失访。大部分病人术后临床症状不同程度改善。术后病人激素水平降低8例,均予氢化可的松、左甲状腺素钠替代治疗,术后初始剂量和维持剂量差异无统计学意义(P>0.05)。随访1年,无肿瘤复发。结论鞍内鞍上型颅咽管瘤行经鼻蝶入路显微手术创伤小、手术时间短、肿瘤切除率高、术后并发症少,能明显改善病人的临床症状。长期规范化随访,适量的激素替代治疗,可以提高病人的生存质量。Objective To explore the therapeutic effect of microsurgery for intra-suprasellar craniopharyngioma via endonasal transsphenoidal approach.Methods Clinical data of 10 patients with intra-suprasellar craniopharyngioma were analyzed retrospectively,who consisted of 4 juveniles and 6 adults.Microsurgery by endonasal transsphenoidal approach was performed in all the patients.Then,clinical symptoms and hormone levels before and after operation were compared.Results Total tumor removal was achieved in 8 patients and subtotal removal in 2,of the latter two,one was treated by gamma knife and the other by endonasal transsphenoidal surgery again.Pituitary stalks were intact in all the patients.One patient died of electrolyte disturbances 1 month after operation,and another was lost to follow-up 4 months after operation.The clinical symptoms were improved to different degrees in most patients after the operation.Endocrine hormones decreased in 8 patients,and all of them were given hydrocortisone and levothyroxine sodium,while there was no significant difference between predose and maintenance dose（P〉 0.05）.During the follow-up period of 1 year,no tumor recurred.Conclusions Microsurgery by endonasal transsphenoidal approach have advantages with less trauma,short operation time,high resection rate,fewer postoperative complications for intra-suprasellar craniopharyngioma,and can obviously improve clinical symptoms.Moreover,it should be emphasized that the standardized long-term follow-up and appropriate hormone replacement therapy are necessary,for improving the quality of life in postoperative patients.

关 键 词：颅咽管瘤 鞍内鞍上型 入路 经鼻蝶窦 显微外科手术 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]