颅咽管瘤显微手术的疗效分析

Analysis of curative effect of microsurgery on craniopharyngiomas (report of 126 cases)

目的探讨颅咽管瘤手术入路的选择及手术疗效。方法 2004年1月至2015年5月手术治疗颅咽管瘤126例,采用翼点入路54例、前纵裂入路21例、经胼胝体入路19例、经鼻蝶入路32例。结果肿瘤全切除87例,近全切除28例,部分切除11例。术后颅内压增高症状均得到缓解;41例内分泌异常患者中改善18例;65例视力障碍患者中52例缓解。术后发生钠代谢紊乱117例、尿崩症82例、高热47例、同侧动眼神经瘫痪4例、意识障碍37例、癫痫8例(经药物治疗后均控制良好)。肿瘤复发12例,经伽玛刀治疗,效果良好。结论术前依据肿瘤的分型选择合适的入路,术中保护好垂体柄、下丘脑及其周围重要神经结构,术后积极处理并发症,对提高患者的生存质量至关重要。

Objeetlve To explore the approach of surgery for craniopharyngiomas and its clinical effect of on them. Method The clinical data of 126 patients with eraniopharyngiomas treated by surgery from January 2015 to May 2004 were analyzed retrospectively. Results Of 126 patients with craniopharyngiomas, 87 received total removal of the tumors, 28 subtotal and 11 partial. The symptoms of intraeranial hypertension were relieved after the operation in all the patients. After the operation, the abnormal endocrine were improved in 18 of 41 patients with endocrine disturbance before the operation and the visual acuity were improved in 52 of 65 with visual acuity impairment 82, high fever in 47, ipsilateral oculomotor nerve palsy in 4, consciousness disturbance in 37 and epilepsy which was controlled by antiepileptic drugs in 8. The tumors which recurred were treated by gamma knife radiotheraphy in 12 patients. Conclusions The appropriate approach of surgery should be selected according to the timorous type in the patients with craniopharyngiomas. The quality of life may be enhanced by the intraoperative good protection of the pituitary stalk, hypothalamus and surrounding nerve structures, post0perative actively treatment of complications in the patients with craniopharyngiomas.