经蝶手术治疗小儿颅咽管瘤的原则与技术

Principles and techniques of the transsphenoidal removal of craniopharyngioma in children

目的评价１９８２年１月～１９９９年６月收治的２５例小儿颅咽管瘤（ｐａｅｄｉａｔｒｉｃｃｒａｎｉｏｐｈａｒｙｎｇｉｏｍａ，ＰＣＰ）采用经蝶入路肿瘤切除术的效果。方法回顾性总结 ２５例 ＰＣＰ的诊断方法，手术技巧和治疗结果。本组均经ＣＦ或ＭＲＩ扫描确诊。经蝶入路行肿瘤切除术。结果５２．０％（１３例）肿瘤全切除；３２ ０％（８例）次全切除；１６．０％（４例）部分切除。肿瘤未能完全切除的原因是瘤体与下丘脑及血管的粘附较紧，或为较大的钙化。术后无死亡。２０例获长期随访（平均３．６年），其中１７例（８５． ０％）恢复良好，３例（１５．０％）肿瘤复发，需再次手术治疗。结论对ＰＣＰ采用ＣＴ或ＭＲＩ进行诊断并选择合适病例经蝶入路显微手术切除，是一种安全、有效的方法。

Objective To assess the effect of the surgical management of the transsphenoidal approach in 25 children with pediatric craniopharyngioma (PCP) treated between January, 1982 and June, 1999. Methods We retrospectively reviewed the diagnostic procedures, surgical techniques, and outcome of the 25 PCP patients. Diagnosis was made by CT or MRI. In these patients the transsphenoidal was adopted to remove the tumor. Results Total tumor removal was accomplished in 13 children (52. 0% ), subtotal removal in 8 children (32. 0% ) and partial removal in the other 4 (.16. 0% ). The main roc for incomplete removal were attachment to the hypothalamus major calcifications, and attachment to vascular structures. No patient died. A long - term follow - up review (median 3. 6 years) in 20 patients found that 17 patients (85.0% ) recovered well, and only 3 patients (15.0% ) encountered recurrence after the operation. The patients with the recurrence of tumor had to be treated again by operation. Conclusion It is a safe and effective method to use CT or MRI to diagnose PCP and to apply microsurgical techniques via the transsphenoidal approach to remove PCP in children.