中国综合临床
中國綜閤臨床
중국종합림상
Clinical Medicine of China
2015年
10期
879-883
,共5页
郑勇%刘宇利%王继超%吴永刚%张诚
鄭勇%劉宇利%王繼超%吳永剛%張誠
정용%류우리%왕계초%오영강%장성
颅咽管瘤%手术%术后并发症
顱嚥管瘤%手術%術後併髮癥
로인관류%수술%술후병발증
Craniopharyngioma%Operation%Postoperative complications
目的 总结手术切除颅咽管瘤的手术经验,分析评估手术治疗效果.方法 回顾性分析新疆维吾尔自治区人民医院神经外科2008年7月至2013年7月开颅显微外科手术切除26例颅咽管瘤患者的临床资料,分析其主要临床表现、影像学特征、选用的手术治疗方案及手术入路、术后肿瘤的切除程度、并发症发生情况及随访预后.结果 6例采用额底+纵裂终板入路,4例行额下入路,5例采用纵裂-胼胝体入路,11例采用翼点入路;全切除19例,次全切除6例,大部切除1例;双侧嗅神经完全保留22例,单侧嗅神经牵拉后离断4例,辨认出垂体柄并保留垂体柄20例,1例前交通动脉破裂出血给予电凝切断;釉质细胞型23例,鳞状上皮细胞型3例;术后发生尿崩18例、电解质紊乱16例、垂体功能下降5例、继发性脑水肿2例、术后发生癫痫1例、死亡1例.追求全切除是尿崩发生因素(x2=4.807,P=0.046);复发5例,3例再次行手术治疗,2例行伽马刀治疗,全切除后肿瘤复发率低于次全切和大部切除(Z=-3.718,P=0.000),Puget肿瘤分级2级患者术后肿瘤复发率高于0级和1级患者(Z=-3.124,P=0.000).生活质量评分(KPS) ≥70分15例,>60~<70分8例,≤60分2例.结论 颅咽管瘤首选手术治疗.术前影像学评估及手术入路选择是手术成功的关键.正确的术中操作、治疗策略,有利于肿瘤切除,有效预防术后并发症.术后肿瘤残留是颅咽管瘤复发主因,复发患者治疗应权衡利弊后采用个体化治疗.
目的 總結手術切除顱嚥管瘤的手術經驗,分析評估手術治療效果.方法 迴顧性分析新疆維吾爾自治區人民醫院神經外科2008年7月至2013年7月開顱顯微外科手術切除26例顱嚥管瘤患者的臨床資料,分析其主要臨床錶現、影像學特徵、選用的手術治療方案及手術入路、術後腫瘤的切除程度、併髮癥髮生情況及隨訪預後.結果 6例採用額底+縱裂終闆入路,4例行額下入路,5例採用縱裂-胼胝體入路,11例採用翼點入路;全切除19例,次全切除6例,大部切除1例;雙側嗅神經完全保留22例,單側嗅神經牽拉後離斷4例,辨認齣垂體柄併保留垂體柄20例,1例前交通動脈破裂齣血給予電凝切斷;釉質細胞型23例,鱗狀上皮細胞型3例;術後髮生尿崩18例、電解質紊亂16例、垂體功能下降5例、繼髮性腦水腫2例、術後髮生癲癇1例、死亡1例.追求全切除是尿崩髮生因素(x2=4.807,P=0.046);複髮5例,3例再次行手術治療,2例行伽馬刀治療,全切除後腫瘤複髮率低于次全切和大部切除(Z=-3.718,P=0.000),Puget腫瘤分級2級患者術後腫瘤複髮率高于0級和1級患者(Z=-3.124,P=0.000).生活質量評分(KPS) ≥70分15例,>60~<70分8例,≤60分2例.結論 顱嚥管瘤首選手術治療.術前影像學評估及手術入路選擇是手術成功的關鍵.正確的術中操作、治療策略,有利于腫瘤切除,有效預防術後併髮癥.術後腫瘤殘留是顱嚥管瘤複髮主因,複髮患者治療應權衡利弊後採用箇體化治療.
목적 총결수술절제로인관류적수술경험,분석평고수술치료효과.방법 회고성분석신강유오이자치구인민의원신경외과2008년7월지2013년7월개로현미외과수술절제26례로인관류환자적림상자료,분석기주요림상표현、영상학특정、선용적수술치료방안급수술입로、술후종류적절제정도、병발증발생정황급수방예후.결과 6례채용액저+종렬종판입로,4례행액하입로,5례채용종렬-변지체입로,11례채용익점입로;전절제19례,차전절제6례,대부절제1례;쌍측후신경완전보류22례,단측후신경견랍후리단4례,변인출수체병병보류수체병20례,1례전교통동맥파렬출혈급여전응절단;유질세포형23례,린상상피세포형3례;술후발생뇨붕18례、전해질문란16례、수체공능하강5례、계발성뇌수종2례、술후발생전간1례、사망1례.추구전절제시뇨붕발생인소(x2=4.807,P=0.046);복발5례,3례재차행수술치료,2례행가마도치료,전절제후종류복발솔저우차전절화대부절제(Z=-3.718,P=0.000),Puget종류분급2급환자술후종류복발솔고우0급화1급환자(Z=-3.124,P=0.000).생활질량평분(KPS) ≥70분15례,>60~<70분8례,≤60분2례.결론 로인관류수선수술치료.술전영상학평고급수술입로선택시수술성공적관건.정학적술중조작、치료책략,유리우종류절제,유효예방술후병발증.술후종류잔류시로인관류복발주인,복발환자치료응권형리폐후채용개체화치료.
Objective To analyze operation resection of craniopharyngioma operation experience,and to evaluation of therapeutic effect of operation.Methods Clinical data of 26 cases patient of craniopharyngioma treated by craniotomy from July 2008 to July 2013 in the Department of Neurosurgery of the People's Hospital of Xinjiang Uygur Autonomous Region for microsurgical operation resection were retrospectively analyzed.The main clinical manifestations, imaging features, the selection of operation treatment and operation approach, extent ofsection of tumor after operation, the occurrence of complications and follow up outcome were analyzed.Results Six cases with brain frontal botton+longitudinal fissure+brain endplate approach,4 cases with brain frontal botton approach, 5 cases with cerebral longitudinal fissure + callosum approach, 11 cases with pterion approach.Total removal was achieved in 19 cases, subtotal resection in 6 cases, most resection in 1 cases.Bilateral olfactory nerve in 22 cases of complete retention, unilateral olfactory nerve stretch mutilation in 4 cases,20 cases of pituitary stalk were identified, and 1 cases of anterior communicans anterior rupture give electrocoagulation cut.Enamel cell type in 23 cases, squamous epithehal cells type 3 cases.Postoperative diabetes insipidus 18 cases, electrolyte disturbances 16 cases, pituitary function decline 5 cases, secondary brain edema 2 cases, 1 case of postoperative epilepsy, 1 cases of death.The pursuit of total was diabetes insipidus factors(x2 =4.807, P =0.046), 5 cases of recurrence, 3 cases go again operztion treatment, 2 cases for the gamma knife treatment, the tumor recurrence rate of total removal lower subtotal resection and most resection (Z =-3.718 P=0.000).The tumor recurrence rate of puget tumor grade level 2 higher than puget tumor grade level 0 and puget tumor grade level 1 (Z =-3.124 P =0.000).The quality of life score (KPS) more than 70 points in 15 cases,60-70 points in 8 cases, ≤60 points in 2 cases.Conclusion Craniopharyngioma preferred operation treatment.Evaluation of preoperative imaging and operation approach is the key to successful operation.The correct operation of the surgery and treatment strategies, advantageous to resection tumor, effective prevention of postoperative complications.Postoperative residual tumor is the main cause of recurrence of craniopharyngioma.Recurrence of craniopharyngioma treatment should individualized therapy after weigh the advantages and disadvantages.