颅咽管瘤的手术治疗和复发因素分析

The study of microsurgical treatment and recurrence factors of craniopharyngioma

目的探讨颅咽管瘤的手术策略和治疗效果以及影响肿瘤复发的因素。方法回顾性分析我经手术治疗的375例颅咽管瘤病人的临床资料,分析和评价不同类型的颅咽管瘤的手术方式、治疗效果和复发情况。结果 375例颅咽管瘤病人中,鞍上型218例,鞍内型43例,三脑室内114例。手术入路选择:经典开颅翼点或额下入路288例,经鼻蝶入路46例,经纵裂胼胝体前入路23例,经皮层脑室入路17例,联合入路1例。经术中观察和术后影像学证实全切272例,次全切103例。术后病人症状改善356例,效果不佳19例,其中死亡5例。结论颅咽管瘤应根据生长方式和特点选择个体化的手术治疗方式。在保护垂体-下丘脑功能基础上的肿瘤的全切仍然是降低复发获得良好预后的关键。

Objective To investigate the effect of surgical strategy and therapy and the factors affecting tumor recurrence in craniopharyngioma. Methods Retrospective analysis clinical data of 375 surgical treatment cases with craniopharyngioma. Evaluate the surgical modalities,techniques and therapeutic effects of different types of craniopharyngioma. Results The growth mode and location of tumor:218 cases above diaphragma sellae,43 cases in diaphragma sellae and 114 cases in three ventricles. Surgical approach selection: classic pterodactory or subordinate approach in 288 cases,transsphenoidal approach in 46 cases,longitudinal corpus callosum approach in 23 cases,cortical ventricular approach in 17 cases,combined approach in 1 cases. Tumors of 272 cases( 72. 53%) were totally removed and 103 cases( 27. 47%) were sub-totally removed,confirmed by intra-operative observing and postoperative imaging.The patients were improved in 356 cases,poor in 19 cases and 5 cases died. Conclusion The individualized surgical treatment is based on the growth pattern and characteristics of craniopharyngioma. The total cut of the tumor with the protection of the pituitary-hypothalamic function remains the key to well prognosis and reducing relapse.