CAJ | 학술논문

目的探讨儿童颅咽管瘤的手术要点及其围手术期处理.方法回顾性分析32例行显微手术治疗的颅咽管瘤患儿的临床资料,总结治疗过程中的体会.结果肿瘤全切除20例,次全切除10例,大部切除2例.其中经翼点入路手术的14例患儿肿瘤全切除7例,次全切除6例,大部切除1例;经额下-纵裂入路手术的18例患儿肿瘤全切除13例,次全切除4例,大部切除1例.术后恢复良好18例,改善12例,死亡2例.术后最常见的并发症为水、电解质代谢紊乱.术后获随访的18例中,肿瘤复发6例,予以再次手术后病情稳定.结论全切除肿瘤是决定颅咽管瘤患儿预后的关键因素,良好的显露是达到肿瘤全切除并保护下丘脑的重要条件,经额下-纵裂入路可提供较好的肿瘤显露,围手术期水、电解质代谢紊乱的治疗和激素补充至关重要.
목적 탐토인동로인관류적수술요점급기위수술기처리.방법 회고성분석32례행현미수술치료적로인관류환인적림상자료,총결치료과정중적체회.결과 종류전절제20례,차전절제10례,대부절제2례.기중경익점입로수술적14례환인종류전절제7례,차전절제6례,대부절제1례;경액하-종렬입로수술적18례환인종류전절제13례,차전절제4례,대부절제1례.술후회복량호18례,개선12례,사망2례.술후최상견적병발증위수、전해질대사문란.술후획수방적18례중,종류복발6례,여이재차수술후병정은정.결론 전절제종류시결정로인관류환인예후적관건인소,량호적현로시체도종류전절제병보호하구뇌적중요조건,경액하-종렬입로가제공교호적종류현로,위수술기수、전해질대사문란적치료화격소보충지관중요.
Objective To explore the key elements of microsurgical procedure and peri-operative management of pediatric craniopharyngiomas.Methods The clinical data of 32 cases of pediatric craniopharyngiomas were retrospec-tively analyzed for microsurgical strategy and therapeutic results.Results Total resection of tumor was achieved in 20 ca-ses,subtotal in 10 cases and partial in 2 cases.Pterional approach was applied in 14 cases with 7 cases of total resection,6 cases of subtotal resection and 1 case of partial resection.Transsubfrontal-translongitudinal approach was applied in 18 cases,with 13 cases of total resection,4 cases of subtotal and 1 case of partial resection.Eighteen cases had good recov-ery,12 cases had improved condition and 2 cases died after surgery.The most common complication was disorders of wa-ter and electrolyte metabolism.Of the 18 followed-up cases,6 cases presented tumor recurrence,and were in stable con-dition after second operation.Conclusion Total removal of tumor with microsurgical technique is the key factor that de-termines the prognosis of pediatric cyraniopharyngiomas.A good exposure is an important factor to achieve total excision of the tumor and sparing of the hypothalamus,and transsubfrontal-translongitudinal approach can help with exposure of cra-niopharyngiomas.Management of water and electrolyte disorders and hormone supplement during peri-operative period is also very important.