摘要
目的 :回顾 7年间 179例手术切除颅咽管瘤的患者 ,总结颅咽管瘤的手术治疗经验。方法 :按与三脑室底的位置关系 ,将肿瘤分为三脑室底上型和三脑室底下型。前者生长于三脑室底上部 ;后者从垂体柄、漏斗、灰结节向上往三脑室底生长阻塞三脑室或向下生长通过鞍膈裂孔进入鞍内。对于三脑室底下型 ,进行翼点入路手术 ,共 15 0例 ,额下入路 16例。对于三脑室底上型采用经胼胝体入路进入三脑室 ,共 13例。在三脑室底下型手术中应特别注意保护进入三脑室底神经结构的穿动脉。三脑室底上型肿瘤经胼胝体入路术中到达三脑室底前部时应避免损伤三脑室底神经结构。结果 :179例手术病例中 ,肿瘤获得全切 16 1例 ,次全切 12例 ,部分切除 6例。垂体柄保留 99例 ,切断 4 6例 ,未发现 34例。所有病人术后随访 3个月到 5年 ,平均 1.5年。随访结果按GOS评分评估。15 4例 (88% )正常生活 ,14例 (8% )生活自理 ,7例 (4 % )生活需要帮助。 7例 (4 % )随访MR发现复发 ,其中 4例为半年内 ,3例为 1年内复发。 5例复发肿瘤再次手术 ,另 2例分别行肿瘤外放疗和伽马刀治疗。结论 :颅咽管瘤切除手术需采用不同的入路以获得最好的显露和最小的肿瘤周围结构损伤。在尝试进行肿瘤全切除时获得好的手术效果的关键是避免损伤下丘脑结构和保?
Objective: To retrospectively review 179 cases surgical treatments of craniopharyngiomas over a 7 year period,surgical experience as following.Methods:Dependent on the locations of the tumors to the floor of the third ventricle, they were classified into the superior type of the third ventricle floor in which tumors grew on the superior part of the third ventricle floor, and the inferior type of the third ventricle floor in which tumors grew from the pituitary stalk, infundibulum, tuber cinereum upwards the floor of the third ventricle developing the obstruction of the third ventricle or downward to the intral sella through the foramen of sellar septum. As the tumor of the inferior type, the pterional approaches were performed in 150 patients and the subfrontal approach in 16 patients. As the superior type, transcallosum into the anterior third ventricle part were undergone in 13 cases. Great care was made to preservie the perforating arteries to the neural structures of the third ventricular floor for the tumor of the inferior type. Avoidance of injury was required to the neural structures of the third ventricular floor when used by the transcallosum approach to the anterior part of the third ventricular floor for the tumor of the superior floor.Results: Total, subtotal and partial removal of the tumor was achieved in 161, 12 and 6 patients, respectively. Four (2.2%) deaths occurred at early postoperative stage. All patients were followed up from 3 months to 5 years (mean, 1.5 years), with 154 (88%) patients regained normal life, 14 (8%) had their self life and the 7 (4%) need assist life. Seven (3.9%) patients experienced their tumor recurrence on MR imaging by following up. Of them, 4 patients were followed up their tumor recurrence within half year and 3 patients within one year. Five patients with recurrent tumor were reoperated on and the other 2 patients were undergone the external radiation of the tumor and γ knife of the tumor respectively. Conclusion: Craniopharyngiomas can be treated surgically with a good result. It is the key to avoid injury of the hypothalamic structures and preserve the perforating arteries to hypothalamus to achieve good surgical results, while attempt was made to completely remove the tumor.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2003年第5期515-520,共6页
Journal of Peking University:Health Sciences
