[1]陈炳霖,王彬彬,骆慧,等.颅咽管瘤显微手术治疗71例分析[J].临床神经外科杂志,2019,16(4):325-331.[doi:10.3969/j.issn.1672-7770.2019.04.010]
 Chen Bing-lin,WANG Bin-bin,LUO Hui,et al.Analysis of 71 cases craniopharyngiomas[J].Journal of Clinical Neurosurgery,2019,16(4):325-331.[doi:10.3969/j.issn.1672-7770.2019.04.010]
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颅咽管瘤显微手术治疗71例分析()
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《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:
16
期数:
2019年第4期
页码:
325-331
栏目:
论著
出版日期:
2019-08-01

文章信息/Info

Title:
Analysis of 71 cases craniopharyngiomas
作者:
陈炳霖王彬彬骆慧季晶刘宁
210029 南京,南京医科大学第一附属医院神经外科
Author(s):
Chen Bing-lin WANG Bin-bin LUO Hui et al.
The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
关键词:
颅咽管瘤手术入路显微外科手术垂体柄疗效
Keywords:
craniopharyngioma surgical approach microsurgery pituitary stalk effect
分类号:
R739.6
DOI:
10.3969/j.issn.1672-7770.2019.04.010
文献标志码:
A
摘要:
【摘要】目的探讨颅咽管瘤显微外科手术入路的选择和影响疗效的因素。方法回顾性分析71例颅咽管瘤患者的临床资料。手术均在显微镜下进行,经翼点入路40例,经额底纵裂入路14例,经鼻蝶入路7例,经眶上外侧入路5例,经纵裂-胼胝体-穹隆间入路3例,经眉弓锁孔入路2例。结果肿瘤全切除者47例,次全切除23例,部分切除1例。30例以视力下降为首发症状的患者中,术后有21例视力明显改善,7例视力较术前下降并于出院前恢复正常水平,2例术侧视力丧失。术后一过性尿崩52例,电解质紊乱34例,内分泌功能紊乱40例,中枢性高热13例,同侧动眼神经麻痹6例,轻度意识障碍6例。随访3~34个月,平均23.5个月,无患者死亡,肿瘤复发者13例。垂体柄保留患者术后出现新发内分泌功能紊乱或紊乱较术前加重的比率低于垂体柄切除者(P<0.05),垂体柄保留与肿瘤复发无关(P>0.05),肿瘤伴有钙化的患者其垂体柄保留率低于不伴钙化者(P<0.05)。结论根据肿瘤的特点选择合理的手术入路,熟练细致的显微神经外科操作以及术中对垂体柄的良好保护,对提高颅咽管瘤患者的手术疗效有重要意义。
Abstract:
Abstract: ObjectiveTo explore the microsurgical approach for craniopharyngioma and the surgical outcomes. MethodsClinical data of 71 patients with craniopharyngioma underwent microsurgical resection were analyzed retrospectively. The operations were performed via pterional approach in 40 cases, frontobasal interhemispheric approach in 14, transsphenoidal approach in 7, lateral supraorbital approach in 5, interhemispheric-transcallosal-interforniceal approach in 3 and supraorbital keyhole in 2. ResultsThe total resection of tumor were achieved in 47 cases, subtotal resection in 23 and partial resection in 1. In 30 patients with vision loss as the first symptom, 21 cases had improved visual acuity after surgery. There was postoperatively transient diabetes insipidus in 52 cases, electrolyte disturbance in 34, abnormal endocrine functions in 40, central high fever in 13, ipsilateral oculomotor palsy in 6 and mild disturbance of consciousness in 6. The patients were followed up for mean period of 23.5 months, ranged from 3 to 35 months. No patients died of the operation. Tumor recurrence occurred in 13 cases. The postoperative endocrine function of patients with pituitary stalk preservation is better than that of patients with pituitary stalk resection(P<0.05), and the preservation of pituitary stalk is independent of tumor recurrence(P>0.05). Patients with tumor calcification have a lower probability of pituitary stalk preservation than those without calcification(P<0.05). ConclusionAn appropriate surgical approach according to the characteristics of the tumor,meticulous microsurgical manipulation and good protection of the pituitary stalk during operation is of great significance for improving the surgical efficacy of patients with craniopharyngioma.

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[2]倪洪早,范月超,陈晨,等.经额下纵裂入路显微切除颅咽管瘤的手术策略[J].临床神经外科杂志,2016,(01):9.
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[4]马逵,王富元,孙维晔,等.侧脑室肿瘤手术治疗策略[J].临床神经外科杂志,2014,(06):449.
[5]毕建华,王小峰,齐春晓,等.《鞍上及鞍内颅咽管瘤经翼点入路和额底入路手术疗效的研究》[J].临床神经外科杂志,2017,14(02):120.
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[6]缪宗,魏栋,陈功,等.多b值弥散加权成像术前预测垂体瘤质地的研究[J].临床神经外科杂志,2019,16(2):123.[doi:10.3969/j.issn.1672-7770.2019.02.007]
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更新日期/Last Update: 2019-08-01