复发颅咽管瘤的综合治疗(附73例临床报道)

Combination of stereotactic surgery with puncturing and implanting Ommaya into the cyst, 32P interstitial radiation,gamma knife and ventricle-abdomen shunt for treating recurring craniopharyngiomas

目的探讨开颅术后复发,再次手术困难的颅咽管瘤的处理方法。方法对73例复发颅咽管瘤联合应用CT引导立体定向囊腔穿刺,置入Ommaya囊,抽吸囊液,32P内放疗,γ刀及脑室-腹腔分流术治疗,长期随访观察疗效。结果除1例巨大单囊性肿瘤术中穿刺时出血,围术期死亡外(1.4%),其余72例患者在手术中抽出囊液后,临床症状迅速改善,多数患者术中即诉说临床症状有好转。术后可随访到67例,随访期6个月～5年,平均3.4年。囊性肿瘤37例中,临床症状及体征消失21例,改善13例,加重3例,影像学检查结果显示病变完全消失11例,缩小22例,增大3例,有效控制率为91.9%;囊实混合性肿瘤30例中,临床症状及体征消失18例,改善9例,加重3例,影像学检查结果显示病变完全消失4例,缩小23例,增大3例,有效控制率为90.0%。复发6例(8.2%)。结论对于复发而不宜继续开颅手术切除的囊性或囊实混合型颅咽管瘤,联合应用立体定向囊腔穿刺、放置Ommaya囊、抽吸囊液,32P内放疗,γ刀及脑室-腹腔分流术等治疗手段,对病人损伤小,并发症少,存活质量高,复发率及病死率均较低,是一种微创、安全、有效、可行的治疗方法,尤以单囊肿瘤和小实体大囊型肿瘤效果较好。

Objective To discuss clinical way for treating recurring and toughly removing craniophatyngiomas. Methods Combination of stereotactic surgery with puncturing and implanting Ommaya into the cyst, aspirating cystic fluid,^32P interstitial radiation,gamma knife and ventricle-abdomen shunt was performed in 73 patients of postoperative recurrent Craniopharyngioma. Long-term follow up was made to evaluate the effectiveness and the safety of the method. Results Except 1 case died from subarachnoid hemorrhage during operation（ 1.4 % ）, the clinical symptom of rest 72 cases were ameliorated rapidly. 67 patients were followed up from 6 months to 5 years（mean 3.4 years）. In 37 cases of cystic tumors,clinical Symptom and physical sign disappeared in 20 cases, improved in 13 cases, worsened in 3 cases. Imaging examination showed tumors were completely disappeared in 12 cases, decreased in 22 cases,increased in 3 cases. The tumor control rate was 91.9% ;In 30 cases of cystic and solid mixing turoms,clinical symptom and physical sign disappeared in 18 cases, improved in 9 cases, worsened in 3 cases. Imaging examination showed tumors were completely disappeared in 4 cases, decreased in 23 cases, increased in 3 cases. The tumor control rate was 90.0 %. 6 cases recurred（8.2 % ）. Conclusion The combination of stereotactic surgery with puncturing and implanting Ommaya into the cyst, aspirating cystic fluid,^32P interstitial radiation, gamma knife and ventricle-abdomen shunt can control the tumors successfully, and it represents a safe and effective method for postoperative recurent craniopharyngiomas.