摘要
目的 探讨颅咽管瘤手术入路的选择及效果.方法 回顾性分析2008年9月至2014年3月解放军总医院采用手术切除的169例颅咽管瘤患者的临床资料、手术入路、疗效和术后并发症.根据术前影像学明确肿瘤的位置、大小及生长方式,采用不同手术入路,其中额下外侧入路11例,额颞入路69例,前纵裂入路57例,经胼胝体入路9例,鼻蝶入路14例,经额中回入路2例,脑室镜下经室间孔入路5例,联合入路2例.术后及时控制尿崩及水电解质紊乱.术后1～3个月复查头颅MRI增强扫描.结果 肿瘤全切除124例（73.4％）,次全切32例（18.9％）,大部分切除13例（7.7％）.垂体柄完整保留104例,部分保留21例.术后1个月内视力无改变99例,视力好转49例,视力较术前下降21例.术后尿崩101例,89例患者术后出现电解质紊乱.随访3 ～ 66个月,平均26.1个月,肿瘤复发26例.结论 通过术前评估,个性化选择合适的手术入路是颅咽管瘤手术成功的关键.
Objective To explore the clinical features,surgical approaches and postoperative outcomes of craniopharyngiomas.Methods A series of 169 consecutive cases of craniopharyngiomas undergoing microsurgical resection via various approaches at our hospital were retrospectively analyzed.There were 102 males and 67 females with a mean age of 34.1 （3-74） years.The operations were performed via unilateral subfrontal （n =11）,frontopterional （n =69）,anterior interhemispheric （n =57）,transcallosal （n =9）,transsphenoidal （n =14）,transcortical （n =2）,transventricular-foramen with neuroendoscope （n =5） and combined （n =2）.Postoperative measures included the managements of blood sodium disorder and diabetes insipidus.During follow-ups,they were monitored for residual or recurrent tumor by postoperative contrast magnetic resonance imaging （MRI） every 1-3 months.Results The removals of lesions were total （n =124,73.4%）,subtotal （n =32,18.9%） and partial （n =13,7.7%）.And 104 cases had an intact preservation of pituitary stalk and stalk was partially preserved in 21 patients.Visual improvement （n =49） and deterioration （n =21） were achieved.The major postoperative complications included diabetes insipidus （n =101） and electrolyte disorder （n =89）.And 26 patients had recurrence during a follow-up period of 26.1 （3-66） months.Conclusion Selection of appropriate approaches according to morphological characteristics is essential for successful microsurgery of craniopharyngiomas.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2015年第11期841-844,共4页
National Medical Journal of China
