颅咽管瘤的显微外科治疗和下丘脑保护

MICROSURGICAL TREATMENT OF CRANIOPHARYNGIOMAS AND HYPOTHALAMIC PROTECTION

目的:探讨显微外科手术治疗颅咽管瘤中对下丘脑保护的治疗策略和技术。方法:2004年6月至2009年6月手术治疗颅咽管瘤39例,根据患者术前评估制定手术策略和方法,Ommaya囊植入加术后32P内放疗3例,肿瘤部分切除加术后放疗9例,肿瘤全切除术27例。对患者的临床资料、手术并发症、出院时状况、肿瘤控制情况和术后生活状况等进行总结。结果:21例获肿瘤全切除或近全切除。术后并发症包括尿崩、水电解质紊乱、视力下降等。随访29例,时间3～60个月。因肿瘤控制不佳或增大再次手术5例;恢复术前工作和学习24例,生活自理3例,生活不能自理1例,死亡1例。结论:手术前根据患者状况制定个体化的手术治疗策略,术中应用显微外科技术保护下丘脑及其穿通动脉,可以降低下丘脑损伤的发生,改善治疗效果。

Objective：To investigate the surgical strategy and technology with ideal hypothalamic protection in microsurgical treatment of crariiopharyngiomas. Methods. From Jun. 2004 to Jun. 2009, 39 patients with craniopharyngiomas were operated in different strategy and methods, which is based on the pre-operation evaluation. Their clinical data, complications, local tumor control and long-term life quality were analyzed retrospectively. Results：The surgical strategy consists of placement of Ommaya reservoir into a cystic craniopharyngioma plus 32p intracavitary irradiation, conservative surgery （partial removal） in combination with radiotherapy, and intended gross total resection. Twenty-one tumors were totally or subtotally removed （53.8%）. Major post operative complications included diabetes insipidus, blood electrolytes disorder and worsened visual function. Twenty-nine cases were followed up with a term of 3 months to 5 years.Five patients had tumor relapse, which needed another operation. Twenty-four patients went back to their normal life and work （82.8%）, 3 cases could take care of themselves in life （10.3%）, one neededassistance for daily life （3.4%）, one died of hypothalamic deficiency （3.4 %）. Conclusion. Individualized surgical strategy in craniopharyngioma combined with operative technology in protection of the hypothalamus and their perforators may lower the incidence of injury to hypothalamus and achieve good surgical resuits.