经额侧脑室联合翼点入路显微切除第三脑室的内颅咽管瘤的临床疗效及并发症防治对策

The clinical efficacy and complication of frontal lateral ventricle countermeasures combined pterional approach for microsurgical resection of the third ventricle in craniopharyngioma

目的分析经额侧脑室联合翼点入路显微切除第三脑室的内颅咽管瘤的临床疗效及并发症防治策略。方法选取我院自2012年10月至2014年10月收治的100例内颅咽管瘤患者作为研究对象,采取随机数字表法分为实验组和对照组,每组各50例,实验组先采取经额部皮质造瘘,侧脑室室间孔入路切除侧脑室和第三脑室内的肿瘤,然后联合翼点入路切除鞍上及鞍旁残留的肿瘤。对照组只采取经额部皮质造瘘,侧脑室室间孔入路切除侧脑室和第三脑室内的肿瘤。术后随访7个月,对比两组患者肿瘤全切率、次全切率、部分切除率以及并发症的发生情况。结果实验组肿瘤全切率、次全切除率、部分切除率分别为82.00%、14.00%、4.00%;对照组肿瘤全切率、次全切除率、部分切除率分别为58.00%、18.00%、24.00%,组间相比具有显著差异(χ2=5.32,P<0.05;χ2=5.27,P<0.05;χ2=5.31,P<0.05)。实验组并发症的发生率为24.00%;对照组并发症的发生率为46.00%,组间相比具有显著差异(χ2=5.65,P<0.05)。结论对于第三脑室的内颅咽管瘤,经额侧脑室联合翼点入路进行显微切除的手术方式,可以清楚查看肿瘤的部位以及肿瘤周围组织结构的具体情况,提高肿瘤的全切率,减少并发症的发生,可以作为一种理想方法应用于临床工作中。

Objective Our retrospective study was aimed to analyze clinical efficacy and complications prevention policies of the lateral ventricle joint pterion microsurgical resection of the third ventricle in the craniopharyngioma.Methods Clinical data of patients with craniopharyngioma at our hospital from October 2012 to October 2014 was retrospectively analyzed.Patients included were divided into two groups according to the random number table,experimental group and control group,50 cases in each group.the patients in the experimental group were taken the frontal cortex fistula of lateral ventricle and interventricular foramen approach for resection of lateral ventricle and the third ventricle tumor,then combined pterional approach for sellar and parasellar residual tumor.The patients in the control group were only taken the frontal cortex fistula of lateral ventricle,interventricular foramen approach for resection of lateral ventricle and the third ventricle tumor.Patients were followed up for 7 months,compared tumor total resection,subtotal resection,partial resection rate of occurrence rate and complications of two groups.Results Total resection rate,subtotal resection rate and partial resection rate in the experimental group was rspectively 82.00%,14.00%,4.00%;Total resection rate,subtotal resection rate and partial resection rate in the control group was rspectively 58.00%,18.00%,24.00%,with significant difference between groups（χ2= 5.32,P〈0.05;χ2= 5.27,P〈0.05;χ2= 5.31,P〈0.05）.the incidence of complications in the experimental group was 24.00%,the incidence of complications in the control group was 46.00%,with significant difference between groups（χ2= 5.65,P〈0.05）.Conclusion For the third ventricle in the craniopharyngioma,by the amount of lateral ventricles joint pterion microscopic surgical resection,we can clearly see the tumor location and the circumstances surrounding the tumor tissue structure,improving the rate of total resection of tumor,reducing the incidence of complications.it can be used as an ideal method for clinical work.