颅咽管瘤切除术与下丘脑功能保护（附1182例报告）  

Preservation of hypothalamic structures in resection of craniopharyngiomas： a report of I 182 cases

作　　者：石祥恩[1,2] 周忠清[2] 吴斌[2] 张永力[2] 钱海[2] 刘方军[2] 孙玉明[2] 杨扬 杨军[1] 于帅宾 

机构地区：[1]首都医科大学附属复兴医院神经外科,北京100038 [2]首都医科大学三博脑科医院神经外科

出　　处：《中华神经外科杂志》2017年第11期1107-1112,共6页Chinese Journal of Neurosurgery

摘　　要：目的探讨颅咽管瘤的手术方法以及术中保护下丘脑功能的意义。方法回顾性纳入2004年4月至2016年12月于首都医科大学附属复兴医院神经外科和首都医科大学三博脑科医院神经外科行手术治疗的1182例颅咽管瘤患者。总结手术方法和预后，并探讨术中垂体柄保留情况与肿瘤钙化、尿崩症以及肿瘤复发的关系。结果1182例患者中，肿瘤全切除1059例（89．6％），近全切除77例（6．5％），大部分切除46例（3．9％）。围手术期死亡23例（1．9％）。共836例（70．7％）接受随访，随访时间为2．0-18．0年，平均（3．74-2．1）年。术前存在视觉障碍的430例患者中，34．1％（31／91）有视力改善，66．4％（225／339）有视野改善。836例中，82．4％（689／836）可正常生活。70．4％（57／81）的患者尿崩症加重，26．2％（289／1101）出现新发尿崩症。48．9％（578／1182）的患者垂体柄完整保留。肿瘤钙化患者的垂体柄保留率低于肿瘤无钙化患者，垂体柄完整保留患者的尿崩症发病率低于垂体柄离断或无法鉴别患者（均P〈0．001）。垂体柄的保留与肿瘤复发无关（P〉0．05）。肿瘤全切除患者的复发率低于非全切除患者。肿瘤全切除患者术后2年和6年生存率均高于非全切除患者（均P〈0．05）。结论开颅手术全切除是颅咽管瘤有效的治疗方法，并无严格的个体肿瘤特征限制。手术采用直接中线显露肿瘤，鉴别下丘结构标志给予有效保护，通过全切除肿瘤，患者可获得良好的预后。Objective To investigate review the surgical outcomes of aggressive resection and the significance of preservation of hypothalamic structures of 1 182 cases of craniopharyngiomas （CP）. Methods A total of 1 182 CP cases were retrospectively enrolled into this study who underwent operations at Department of Neurosurgery, Fu Xing Hospital, Capital Medical University and Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University between April 2004 and December 2016. The surgical approaches and prognosis were summarized. The relationship between preservation of hypothalamic structures and tumor calcification, diabetes insipidus （DI） or recurrence of the tumor was investigated. Results Total, subtotal, and partial tumor removal was achieved in 89. 6% （1 059 cases ）, 6. 5% （77 cases）, and 3.9% （46 cases） of all patients, respectively. There were 23 （ 1.9% ） perioperative deaths. A total of 836 （70.7%） patients were followed up for 2.0 - 18.0 years with an average of 3, 7 - 2.1 years. Among 430 patients with preoperative visual impairment, the visual acuity was improved in 31/91 （34, 1% ） patients and the visual field was improved in 225/339 （66.4%） patients. A total of 689/863 （ 82.4% ） patients recovered to normal life. DI deteriorated in 57/81 （70.4%） cases and newly-onset DI occurred in 289/1 101 （26.2%） patients. Total pituitary stalk（PS） preserration were achieved in 578/1 182（48.9% ） patients. The rate of PS preservation was significantly lower in patients with calcified tumors compared with that in patients with non-calcified tumors （P 〈 O. 001 ）. PS preservation was responsible for DI （P 〈 0.001 ）, but no difference in the tumor recurrence rate was observed between PS preservation and non-reservation cases （P 〉 0.05）. The rate of recurrent tumor was lower in patients with total tumor removal than that in patients with subtotal tumor removal. The survival rates at 2 years and 6 years post surgery were higher in patients wi

关 键 词：颅咽管瘤 神经外科手术 预后 下丘脑保护 

分 类 号：R739.41[医药卫生—肿瘤]