三种纵裂入路在下丘脑区肿瘤切除的应用  

Application of three interhemispheric approach in tumor resection of hypothalamic region

作　　者：张洪亮 李环廷[1] 吕炳科 郭品 程德奎 丰育功[1] 刘伟[1] Zhang Hongliang;Li Huanting;Lv Bingke;Guo Pin;Cheng Dekui;Feng Yugong;Liu Wei(Department of Neurosurgery,the Affiliated Hospital of Qingdao University,Qingdao,Shandong 266000,China)

机构地区：[1]青岛大学附属医院神经外科,青岛266000

出　　处：《中国微侵袭神经外科杂志》2021年第6期245-249,共5页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：山东省自然科学基金(编号:ZR2016HB64)。

摘　　要：目的探讨三种纵裂入路在下丘脑区肿瘤(tumor in the hypothalamus region,THR)切除的应用。方法回顾性分析73例位于中线的THR,根据病变与视交叉、前交通动脉、第三脑室的关系,THR分为A型17例、B型31例、C型25例,分别采取经纵裂-胼胝体-穹隆间入路、经纵裂-前交通动脉-终板入路、经额底-纵裂-视交叉入路进行肿瘤切除。结果病理类型:颅咽管瘤58例、下丘脑错构瘤2例、下丘脑胶质瘤5例,生殖细胞瘤3例,巨大垂体瘤3例,巨大鞍结节脑膜瘤2例。A、B、C三型肿瘤软硬度差异无统计学意义(P>0.05)。肿瘤全切除64例,次全切除6例,部分切除3例。肿瘤全切率为87.7%,其中A型为76.5%,B型为87.1%;C型为92.0%,三型间肿瘤全切率差异无统计学意义(P>0.05)。术后恢复良好(KPS 80~100分)63例(86.3%),中等(KPS 40~70分)7例(9.6%),不良(KPS 0~30分)3例(4.1%)。结论通过对THR进行临床分型,针对性选择不同手术入路,可获得良好切除效果。Objective To explore the application of three interhemispheric approaches in the resection of tumors in the hypothalamus region(THR).Methods The clinical data of 73 patients with THR located in the midline were analyzed retrospectively.According to the relationship between the lesion and the optic chiasm,the anterior communicating artery and the third ventricle,the THR were divided into 17 cases of type A,31 of type B,and 25 of type C.Tumor resection was performed through longitudinal fissure-corpus callosum-fornix approach,longitudinal fissure-anterior communicating artery-endplate approach and frontal base-longitudinal fissure-optic chiasma approach respectively.Results The pathological types included craniopharyngioma in 58 cases,hypothalamic hamartoma in 2,hypothalamic glioma in 5,germ cell tumor in 3,giant pituitary tumor in 3,and giant tuberculum sellae meningioma in 2.There was no significant difference in the softness and hardness of the three types of tumors A,B,and C(P>0.05).Total tumor resection was achieved in 64 cses,subtotal resection in 6,and partial resection in 3.The tumor total resection rate was 87.7%,of which type A was 76.5%,type B 87.1%,and type C 92.0%.There was no significant difference in tumor total resection rate between the three types(P>0.05).Postoperative recovery was good(KPS 80-100)in 63 cases(86.3%),moderate(KPS 40-70)in 7(9.6%),and poor(KPS 0-30)3(4.1%).Conclusion Through the clinical classification of THR and the targeted selection of different surgical approaches,a good resection effect can be obtained.

关 键 词：下丘脑肿瘤 纵裂入路 肿瘤分类 

分 类 号：R739.41[医药卫生—肿瘤]