216例颅咽管瘤的显微手术治疗

Microsurgery for craniopharyngiomas(report of 216 cases)

目的探讨颅咽管瘤的手术方法及其治疗效果。方法对我科手术治疗的216例颅咽管瘤患者的临床资料进行回顾性分析。结果肿瘤全切除187例(86.6%),近全切除18例(8.3%),部分切除11例(5.1%)。术后出现尿崩197例,出院时尿量恢复正常83例,尿量好转78例,仍有尿崩36例;171例发生钠代谢紊乱,出院时血钠正常149例,仍有钠代谢紊乱22例;53例发生高热,出院时体温均正常;44例发生意识障碍,8例因长期昏迷死亡,26例在出院时意识清楚;13例出现癫痫,其中2例死于癫痫持续状态,其余11例得到良好控制。结论术前仔细阅读影像学资料,依据肿瘤的生长部位选择合适的入路是手术成功的关键,术中娴熟的手术技巧及术后并发症的处理对于提高肿瘤的全切除率和患者的生存质量至关重要。

ObjectiveTo explore the microsurgical technique to treat craniopharyngiomas.MethodThe clinical data of 216 patients with craniopharyngiomas, who underwent microsurgery from January, 1999 to December, 2012, were analyzed retrospectively.ResultsOf 216 patients with craniopharyngiomas, 187（86.57%） received the total removal of the tumors, 18（8.33%） subtotal and 11（5.09%） partial. Of 197 patients who suffered from diabetes insipidus after the operation, 83 were recovered clinically, 78 improved and36 still had diabetes insipidus on discharge from hospital. Of 171 patients who suffered from blood sodium disorders after the operation,149 were cured and 22 still had the blood sodium disorders when they left hospital. The body temperature returned to normal when theyleft hospital in 53 patients with hyperpyrexia. Of 44 patients with postoperative coma, 8 died, 26 were recovered and 10 still had coma.Of 13 patients with postoperative epilepsy, 11 were cured and 2 died of status epilepticus.ConclusionsCarefully reading image databefore the operation, and selection of appropriate operative approach according to the cerebral area where the tumor is are the key to thesuccess of microsurgery for the craniopharyngiomas. The skillful microsurgical technique and correct treatment of the postoperativecomplications are very important to the increase in the rate of the total resection of tumor and life quality in the patients withcraniopharyngiomas.