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目的总结颅咽管瘤显微外科手术治疗的临床近期和远期效果,探讨影响手术效果的因素。方法回顾性分析2010年8月至2013年10月收治的37例颅咽管瘤患者的临床资料。所有患者均在显微镜下采用经翼点、经胼胝体-透明隔间隙-穹隆间及经额部纵裂等4种入路切除鞍区和第三脑室内的颅咽管瘤,术后随访,记录内分泌、代谢、视力和视野改变及肿瘤复发情况。结果 37例患者中,全切+次全切34/37例(91.9%),全切除肿瘤且保留垂体柄8例(21.6%)。术后主要并发症:暂时性尿崩26例,长期尿崩症2例;电解质紊乱14例;癫3例,中枢性高热2例,动眼神经损伤3例,垂体功能永久性低下3例;术后1周内死亡1例。随访时间12个月至3.5年,平均2.8年,36例中复发28例,死亡1例。按格拉斯哥预后(GOS)评分,5分30例,4分4例,3分2例,1分1例。结论显微外科手术是治疗颅咽管瘤有效和安全的方法,在保护好下丘脑的同时实现颅咽管瘤的全切除将有利于延长术后生存时间、降低肿瘤复发率和提高生活质量,辅助放射治疗有助于延长不能全切患者的生存期。
Objective To summarize the clinical short-term and long-term effects of microsurgical treatment of craniopharyngiomas and to explore the factors affecting the surgical results. Methods The clinical data of 37 patients with craniopharyngioma admitted from August 2010 to October 2013 were retrospectively analyzed. All patients were under the microscope using the wing point, via the corpus callosum - transparent septum - intervertebral space and the amount of longitudinal slitting and other four kinds of approach to remove the sellar region and the third ventricle craniopharyngioma, postoperative follow-up, record Endocrine, Metabolism, Vision and Vision Changes and Tumor Recurrence. Results Total 37 cases (91.9%) underwent total and complete subtotal resection of the tumor and 8 cases (21.6%) retained the pituitary stalk. There were 26 cases of transient diabetes insipidus, 2 cases of long-term diabetes insipidus, 14 cases of electrolyte imbalance, 3 cases of epilepsy, 2 cases of central hyperthermia, 3 cases of oculomotor nerve injury and 3 cases of permanent hypopituitarism. One patient died within 1 week after operation. The follow-up time ranged from 12 months to 3.5 years with an average of 2.8 years. Of the 36 cases, 28 cases relapsed and 1 died. According to Glasgow’s prognosis (GOS) score, 5 points and 30 cases, 4 points and 4 cases, 3 points and 2 cases, 1 point and 1 case. Conclusion Microsurgery is an effective and safe method for the treatment of craniopharyngioma. To achieve the total resection of craniopharyngiomas while protecting the hypothalamus will be beneficial to prolong the survival time, reduce the recurrence rate and improve the quality of life. Adjuvant radiotherapy can help prolong the survival of patients who can not be fully resected.