13例颅咽管瘤全切术及并发症的防治体会

Total removal of craniopharyngioma and treatment of complications: experience with 13 patients

目的探讨颅咽管瘤全切术的手术方法和术后并发症的防治措施。方法术前测基础代谢率,激素替代疗法和预防癫痫。手术主要采用翼点、额下入路,应用显微外科技术从鞍区各个手术间隙分块切除。术后严密观测病人的意识,尿量和血清电解质,及时防治尿崩症电解质紊乱,预防癫痫和激素替代治疗。结果11例病人显微镜下肿块全切,2例肿块少部分残留,术后无明显神经功能障碍。10例发生尿崩症,9例发生电解质紊乱,5例发生体温失衡。经处理后,电解质紊乱,体温失衡完全纠正,尿崩症痊愈。结论选择最合适的手术入路,熟悉充分利用鞍区各个解剖间隙是完成肿瘤全切的关键;术前采用激素替代疗法,术后严密监测尿量、电解质,积极处理并发症,可有效降低手术死亡率。

[Objective] To investigate the method of total resection of craniopharyngioma and prevention and treatment of post-operative complications. [Methods] Pterion craniotomy for 9 cases and frontbasal approach for 4 ease were perfomed respectively after giving glucocorticoid and anti- epilepsy drug and testing BMR. The tumors were removed via the 4 anatomy space in sellar region by employing microsurgical technique, consciousness, urine volume, serum electrolyte of patients weir observed strictly after sugery, and complications such as diabetes insipidus, serum electrolyte disorders and epilesy were treated in time. [Result] Total removals of tumors were achieved in 11 eases and minor po：ion of tumors was left in 2 eases, there was not obvious deficit of nervous system function in all of the patients after surgery. Diabetes insipidus, serum electroyte disorder and temperature disorder ocurred in 10 cases, 9 cases and 5 cases respeetively. After treatment diabetes insipidus electrolyte disorder and body temperature disorder were rectified in all cases. [Conclusion] Choosing the best operation approach according to the scope of tumor invasion and being familiar with the sellar anatomy spaces were the keys to remove craniopharyngioma completely. Giving glacocorticoid before operation and active treament of complications could effectively decrease mortality.