颅咽管瘤显微手术疗效分析  

Efficacy analysis of microsurgery for craniopharyngioma

作　　者：王跃龙[1] 刘志勇[1] 杨金龙 李高伟 周良学[1] 姜曙[1] 蔡博文[1] 游潮[1] 徐建国[1] Wang Yuelong;Liu Zhiyong;Yang Jinlong;Li Gaowei;Zhou Liangxue;Jiang Shu;Cai Bowen;You Chao;Xu Jianguo(Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China)

机构地区：[1]四川大学华西医院神经外科,成都610041

出　　处：《中国微侵袭神经外科杂志》2018年第5期197-200,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：国家科技支撑计划(编号:2014BAI04B01)

摘　　要：目的探讨颅咽管瘤手术入路的选择与疗效。方法回顾性分析371例采用手术治疗的颅咽管瘤病例资料,采用额下翼点入路167例,经额部纵裂入路和经终板入路93例,经前部胼胝体-透明隔间隙-穹隆间入路74例,经鼻蝶入路37例。结果肿瘤全切除256例,近全切除82例,部分切除33例。术后颅内压增高症状均得到缓解;在214例术前视力下降病人中,缓解152例。术后发生钠代谢紊乱334例,尿崩症241例,高热123例,同侧动眼神经麻痹12例,意识障碍89例,癫疒间23例(经药物治疗后均控制良好)。196例(52.8%)病人获得随访,时间3~69个月,平均35.7个月,死亡17例(8.7%)。肿瘤复发35例,其中再次手术20例,伽玛刀治疗15例。结论术前依据肿瘤分型选择合适手术入路,术中保护好垂体柄、下丘脑及其周围重要神经结构,术后积极处理并发症,对提高病人生存质量至关重要。Objective To explore the surgical approach of craniopharyngioma and the surgical outcome. Methods The clinical data of 371 patients with craniopharyngioma undergoing surgery were analyzed retrospectively. The surgery was performed via subfrontal the pterional approach in 167 cases, via unifrontal basal interhemispheric approach in 93, via anterior callosal-cavum septum pellucidum-interforniceal approach in 74, and transsphenoidal approach in 37. Results The total resection of tumor were achieved in256 cases, subtotal resection in 82, and partial resection in 33. Postoperative increased intracranial pressure was relieved. The decrase of vision remitted in 152 of 214 patients. There was sodium metabolism disturbance in 334 cases, diabetes insipidus in 241,hyperthermia in 123, ipsilateral oculomotor nerve palsy in 12, disturbance of consciousness in 89 and epilepsy in 23（ All were controlled by drug treatment）. The 196 patients（52.8%） were followed-up for 3 to 69 months with a mean period of 35.7 months. The death occurred in 17 cases（8.7%）. The recurrence tumors were seen in 35 patients, reoperation was performed in 20 cases and gamma knife in 15. Conclusions The appropriate approach is selected according to the classification of tumor before operation. The intraoperative protection of pituitary stalk, hypothalamus and its surrounding important nerve structure, postoperative treatment of complications are essential for improving the patient＇s quality of life.

关 键 词：颅咽管瘤 显微外科手术 手术入路 

分 类 号：R739.41[医药卫生—肿瘤]