经额底纵裂入路在切除颅咽管瘤显微外科切除手术中的应用

Application of subfrontal trans longitudinal fissure approach for craniopharyngioma resection in microsurgery

目的探讨经额底纵裂入路在切除颅咽管瘤显微外科手术中的应用及临床疗效。方法回顾性分析53例采用经额底纵裂入路和46例采用经翼点入路手术治疗的颅咽管瘤患者的临床资料。分析比较经额底纵裂入路与翼点入路患者的肿瘤切除率及术后并发症的发生率。结果额底纵裂入路组44例患者的肿瘤全切除,全切率为83.0%;翼点入路组36例患者的肿瘤全切除,全切率为78.3%;两组患者全切率对比差异无统计学意义(P=0.549)。额底纵裂入路组患者术后并发尿崩、电解质紊乱的发生率明显低于翼点入路组,差异有统计学意义(P=0.004,P=0.030)。结论经额底纵裂入路切除颅咽管瘤,利用生理间隙,具有视角佳、操作空间大、适用范围广、安全性高等优点,是显微外科手术切除颅咽管瘤时的重要入路之一。

Objective To investigate the application and clinical effect of craniopharyngioma resection through the subfrontal longitudinal fissure approach in microsurgery.Methods the clinical data of 53 patients with craniopharyngioma treated by transfrontal longitudinal fissure approach were retrospectively analyzed.46 cases of craniopharyngioma were selected and compared with them.The differences of resection rate and postoperative complications between the two approaches were analyzed.Results The total resection rate was 83.0%in 44 cases through the longitudinal frontal fissure approach,and the total resection rate was 78.3%in the pterional approach group.There was no significant difference in the resection rate between the two approaches(P=0.549).The incidence of electrolyte turbulence(P=0.030)and diabetes insipidus(P=0.004)in the pterional approach group were more likely to occur than those in the trans pterional approach(P<0.05).Conclusion Subfrontal trans longitudinal fissure approach is one of the most important approaches in microsurgery for craniopharyngioma because of its advantages of good view,large operation space,wide application range and high safety.