神经内镜扩大经鼻入路与开颅入路切除颅咽管瘤对比分析  

Comparative analysis between extend endoscopic endonasal and open transcranial resection for craniopharyngiomas

作　　者：谭松[1] 阮伦亮 靳凯[1] 王福超[1] 牟家民 黄华[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,重庆400016

出　　处：《中国神经精神疾病杂志》2017年第10期577-581,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：国家临床重点专科建设项目(编号:财社[2011]170号);重庆市自然科学基金(编号:CSTC2013jcyj Al0079)

摘　　要：目的对比分析神经内镜扩大经鼻入路与开颅入路切除颅咽管瘤的疗效和并发症。方法回顾分析46例神经内镜扩大经鼻入路和54例开颅入路切除颅咽管瘤患者的临床资料,比较两种术式的肿瘤切除率、住院时间及术后并发症。结果内镜组较开颅组肿瘤直径更大[(3.5±1.3)cm vs.(3.0±0.8)cm,P<0.05],切除率更高(67.4%vs.46.3%,P<0.05),术后视力、视野损害改善更佳(84.2%vs.59.5%,P<0.05),而术后腺垂体功能减退(56.5%vs.75.9%,P<0.05)、永久性尿崩症(51.4%vs.72.7%,P<0.05)的发生率更低,但脑脊液漏发生率更高(4.3%vs.0.0%,P>0.05),住院时间更长[(17.0±3.6)d vs.(13.1±2.3)d,P<0.01]。嗅觉减退(34.8%)和鼻出血(2.2%)为内镜组特有的并发症。结论神经内镜扩大经鼻入路切除颅咽管瘤相比开颅入路肿瘤全切率、临床症状缓解率更高,部分并发症更低,是一种微创、有效的治疗方法。Objective To compare the efficacy and complications of the extend endoscopic endonasal approach （EEA） and open transcranial approach for resection of craniopharyngiomas. Methods The clinical data from 46 patients with craniopharyngiomas with extend EEA and 54 patients with transcranial route in our department was analyzed retrospectively. The gross total resection （GTR） rate,length of hospital stays and complications of the two groups were compared. Results The tumor diameters of were larger in the endoscopic group than in the transeranial group （3.5± 1,3cm vs. 3.0±0.8 cm, P〈0.05）. The endoscopic group had a greater GTR rate （67.4% vs. 46.3%, P〈0.05）and improved visual outcome （84.2% vs. 59.5%, P〈0.05）, but lower rate of hypopituitarism （56.5% vs. 75.9% ,P〈0.05）and permanent diabetes insipidus （51.4% vs.72.7% ,P〈0.05）. On the contrast, the endoscopic group had a greater rate of cerebrospinal fluid leak（4.3% vs. 0.0%,P〉0.05）and longer hospital stays（17.0±3.6 d vs. 13.1±2.3 d,P〈0.01）. Hyposmia（34.8%）and hemorrhinia （2.2%）only happened in the endoscopic group. Conclusion Compared with transcranial route, the extend EEA for craniopharyngiomas is minimal invasion and effective, which can effectively improve the GTR rate and reduce the clinical symptoms.

关 键 词：颅咽管瘤 神经内镜 扩大经鼻入路 开颅入路 预后 

分 类 号：R739.4[医药卫生—肿瘤]