颅咽管瘤显微手术治疗及疗效分析

Microsurgical treatment and efficacy of patients with craniopharyngioma

目的探讨颅咽管瘤的显微手术方法及疗效。方法回顾性分析武警总医院2010-01至2014-12收治的136例颅咽管瘤患者的临床资料。手术均在显微镜下进行,其中采用额底纵裂入路42例,额下入路28例,胼胝体穹窿间入路27例,翼点入路36例,经蝶窦入路3例。结果本组肿瘤全切除118例,次全切除14例,大部分切除4例。术后出现尿崩症63例(暂时性尿崩症42例),视力下降或失明28例,电解质紊乱65例。其他并发症:中枢性高热8例,动眼神经损伤3例,脑梗死1例,颅内感染2例。术后1个月内出现死亡3例,死因均为下丘脑综合征。因病情危重或经济原因放弃治疗办理自动出院3例。结论根据肿瘤的生长部位、比邻关系和生长方式,合理地选择手术入路是颅咽管瘤手术成功的关键。

Objective To explore the therapeutic effect of microsurgical methods on craniopharyngioma. Methods The clinical data of 136 cases of patients with craniopharyngioma treated in our hospital between January 2010 and December 2014 were retrospectively analyzed. Operations were performed under the microscope. The the fronto basal interhemispheric approch was adopted in 42 cases,subfrontal approach in 28 cases,callosal interforniceal approach in 27 cases,pterional approach in 36 cases,and the transsphenoidal approach in 3 cases. Results Total tumor removal was achieved in 118 cases,subtotal removal in 14 cases,and partial removal in 4 cases. Also,there were 63 cases of postoperative diabetes insipidus（ temporary diabetes insipidus in 42 cases）,and 28 cases of decreased vision or blindness. Electrolyte disorders occurred in 65 cases. As for other complications,there were 8 cases of central high fever,3 cases of oculomotor nerve injury,1 case of cerebral infarction,2 cases of intracranial infection. And 3 cases of death one month after operation. There were also 3 cases of automatic discharge,who gave up treatment because of the severity of illness or for financial reasons. Conclusions Selection of an appropriate surgical approach based on the location and growth mode of the craniopharyngioma is the key to the success of surgical treatment.