颅咽管瘤26例临床分析

Retrospective analysis operation treatment of 26 cases of craniopharyngioma

目的总结手术切除颅咽管瘤的手术经验，分析评估手术治疗效果。方法回顾性分析新疆维吾尔自治区人民医院神经外科2008年7月至2013年7月开颅显微外科手术切除26例颅咽管瘤患者的临床资料，分析其主要临床表现、影像学特征、选用的手术治疗方案及手术入路、术后肿瘤的切除程度、并发症发生情况及随访预后。结果6例采用额底＋纵裂终板入路，4例行额下入路，5例采用纵裂．胼胝体入路，11例采用翼点入路；全切除19例，次全切除6例，大部切除1例；双侧嗅神经完全保留22例，单侧嗅神经牵拉后离断4例，辨认出垂体柄并保留垂体柄20例，1例前交通动脉破裂出血给予电凝切断；釉质细胞型23例，鳞状上皮细胞型3例；术后发生尿崩18例、电解质紊乱16例、垂体功能下降5例、继发性脑水肿2例、术后发生癫痫1例、死亡1例。追求全切除是尿崩发生因素（χ2=4．807，P=0．046）；复发5例，3例再次行手术治疗，2例行伽马刀治疗，全切除后肿瘤复发率低于次全切和大部切除（z=- 3．718，P=0．000），Puget肿瘤分级2级患者术后肿瘤复发率高于0级和1级患者（Z= -3．124，P=0．000）。生活质量评分（KPs）≥70分15例，〉60～〈70分8例，≤60分2例。结论颅咽管瘤首选手术治疗。术前影像学评估及手术入路选择是手术成功的关键。正确的术中操作、治疗策略，有利于肿瘤切除，有效预防术后并发症。术后肿瘤残留是颅咽管瘤复发主因，复发患者治疗应权衡利弊后采用个体化治疗。

Objective To analyze operation resection of craniopharyngioma operation experience,and to evaluation of therapeutic effect of operation. Methods Clinical data of 26 cases patient of craniopharyngioma treated by craniotomy from July 2008 to July 2013 in the Department of Neurosurgery of the People＇s Hospital of Xinjiang Uygur Autonomous Region for microsurgical operation resection were retrospectively analyzed. The main clinical manifestations, imaging features, the selection of operation treatment and operation approach, extent ofsection of tumor after operation,the occurrence of complications and follow up outcome were analyzed. Results Six cases with brain frontal bottoM ＋longitudinal fissure ＋ brain endplate approach, 4 cases with brain frontal bottom approach, 5 cases with cerebral longitudinal fissure ＋ callosum approach, I1 cases with pterion approach. Total removal was achieved in 19 cases, subtotal resection in 6 cases, most resection in 1 cases. Bilateral olfactory nerve in 22 cases of complete retention, unilateral olfactory nerve stretch mutilation in 4 cases,20 cases of pituitary stalk were identified, and 1 cases of anterior communicans anterior rupture give electrocoagulation cut. Enamel cell type in 23 cases, squamous epithelial ceils type 3 cases. Postoperative diabetes insipidus 18 cases,electrolyte disturbances 16 cases,pituitary function decline 5 cases, secondary brain edema 2 cases, 1 case of postoperative epilepsy, 1 cases of death. The pursuit of total was diabetes insipidus factors （ χ2 = 4. 807, P = 0. 046）, 5 cases of recurrence, 3 cases go again operztion treatment, 2 cases for the gamma knife treatment,the tumor recurrence rate of total removal lower subtotal resection and most resection （ Z =-3. 718 P=0. 000）. The tumor recurrence rate of puget tumor grade level 2 higher than puget tumor grade level 0 and puget tumor grade level 1 （ Z = - 3.124 P = 0. 000）. The quality of life score （ KPS ） more than 70 points in 15 cases,60-70 points in 8 cases, ≤60 points in 2 cases. Conclusion Craniopharyngioma preferred operation treatment. Evaluation of preoperative imaging and operation approach is the key to successfuloperation. The correct operation of the surgery and treatment strategies, advantageous to resection tumor, effective prevention of postoperative complications. Postoperative residual tumor is the main cause of recurrence of craniopharyngioma. Recurrence of craniopharyngioma treatment should individualized therapy after weigh the advantages and disadvantages.