颅咽管瘤疗效与治疗方案选择

Relationship between Curative Effect and Treatment Methods in patients with Craniophryngiomas

目的分析颅咽管瘤治疗效果,并探讨治疗方案与疗效的关系。方法华西医院神经外科从1997年1月至2004年2月间治疗184例颅咽管瘤患者,分单纯手术切除、手术+放射外科治疗、非手术治疗三组,分析三组治疗效果和随访情况。结果各治疗方案具有相应的并发症、死亡率、致残率和复发率。并发症以下丘脑损害后症状复杂,发生率63.59%;垂体功能低下发生率53.26%;术后视力减弱或视野缺损加重的有11.41%,其他还有无菌性脑膜炎、脑脊液鼻漏、暂时性偏瘫、缄默性失语、创伤性动脉瘤、癫痫等。平均随访4.36年,16例失访,总体死亡率13.04%。三组治疗效果具有差异,以一次性手术全切除最佳,手术不完全切除结合放疗次之,非手术组疗效最差。总体复发率23.91%,非手术治疗组复发率最高,达33.85%(22/65),手术切除组最低,为16.22%(12/74)。结论三种治疗方案远期效果以手术切除组效果最佳。颅咽管瘤是富于挑战性的手术,并发症发生率高,易复发,必要时可结合多种治疗手段以提高疗效。

Objective To explore the relationship between the curative effect and treatment methods in the patients with craniophryngiomas. Methods One hundred eighty-four patients with craniophryngiomas, who were treated in our hospital from January 1997 to February 2004, were divided into three groups, i.e. simple operation, operation plus postoperation radiotherapy and nonoperafive treatment groups. The curatuive effect and follow-up outcome were analysed in the patients of three groups. Results There were specific mortality, and rates of disability, recurrence and compications occurence in every group. The total occurrence rate of hypothalamus injury symptoms including disfunction of body temperature regulation, abnormal orexia., endodriological disturbance and so on was 63.59% in the 184 patients with craniophryngiomas. The occurrence rate of pituitary hypofunction was 53.26%, and the rate of vision acuity dysfunction or vision field defect was 11.43%. The other complications included aseptic meningitis, craniospinal fluid nasal hydrorrhea, transient hemiparesis, mutism, traumatic aneurysm, epilepsy and so on. Of 184 patients, 168 were averagely followed up for 4.36 year after the treatment and 16 were lost. The total mortality was 13.04%. The total recurrence rate of the tumors was 23.91%. The recurrence rates of the tumors in the simple operation, operation plus radiotherapy and conservative treatment groups were 16.22%（12/74）, 22.22%（10/45） and 33.85%（22/65） respectively, and were significantly different from each other among the three groups （P〈0.01）. Conclusions The curative effect in the simple operation group, where the tumors were totally removed, was better than that in the operation plus radiotherapy group, where the tumors were partly removed. The curative effect in the non-operation group is the worst among the three groups, The total removal of the tumors by the operation is the best choice in the patients with craniophryngiomas.