儿童鞍区肿瘤的治疗策略

Treatment strategies for sellar tumors in children

目的探讨儿童鞍区肿瘤的诊断、手术治疗及效果。方法回顾性分析我院自2014年1月至2017年5月170例儿童鞍区肿瘤资料,根据肿瘤的具体位置及大小选择手术入路,其中额下入路90例、翼点入路30例、纵裂-胼胝体入路30例、额下联合纵裂入路20例。术后病理诊断颅咽管瘤90例,生殖细胞瘤45例,视神经胶质瘤20例,垂体瘤8例,下丘脑错构瘤7例。结果全切132例,次全切23例,大部分切除15例,术后死亡4例。出院后随访3个月~3年,术后接受放化疗72例,肿瘤复发25例,再次手术10例。结论根据肿瘤生长位置和大小选择合适手术入路,提高全切率是儿童鞍区肿瘤治疗的关键,术后的放化疗亦不容忽视。

Objective To examine the diagnosis, surgical treatment, and treatment outcome for sellar tumors in children. Methods The clinical data of 170 children with sellar tumors in our hospital from January 2014 to May 2017 were reviewed. Surgical approach was selected based on the patients＇ tumor location and size. Of the 170 patients, 30 were treated via the pterional approach, 90 were treated via the subfrontal approach, 30 were treated via the corpus callosum approach, and 20 were treated via the subfrontal and corpus callosum approach. Postoperative pathological examination revealed 90 cases of craniopharyngeal tumor, 45 cases of germ cell tumor, 25 cases of optic nerve glioma, 8 cases of pituitary adenoma, and 7 cases of hypothalamic hamartoma. Results Among the 170 children, 132 had total resection, 23 had subtotal resection, 15 had partial resection, and 4 died after surgery. All patients were followed up for 3 months to 3 years. Furthermore, 52 patients received postoperative radiotherapy and chemotherapy, 25 had recurrent tumor, and 10 underwent secondary operation. Conclusions The selection of surgical approach based on tumor location and size and improvement of total resection rate are key steps in the treatment of sellar tumors in children. Postoperative radiotherapy and chemotherapy are also very important.