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《临床神经外科杂志》[ISSN:1672-7770/CN:32-1727/R]

卷:

17

期数:

2020年05期

页码:

543-548

栏目:

论著

出版日期:

2020-10-13

文章信息/Info

Title:

Comparison of advantages of lateral supraorbital approach and pterional approach in craniopharyngioma surgery

文章编号:

202005013

作者:

季骋远; 王中; 朱昀; 王伟; 孙晓欧

215006 苏州，苏州大学附属第一医院神经外科

Author(s):

JI Cheng-yuan;  WANG Zhong;  ZHU Yun;  et al.

Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China

关键词:

眶上外侧入路; 翼点入路; 颅咽管瘤; 手术切除

Keywords:

lateral supraorbital approach pterional approach craniopharyngioma surgery

分类号:

R739.41

DOI:

DOI:10.3969/j.issn.1672-7770.2020.05.013

文献标志码:

A

摘要:

目的探讨经眶上外侧入路与经翼点入路手术治疗颅咽管瘤的疗效及并发症。方法回顾性分析苏州大学附属第一医院神经外科2012年8月—2018年8月，经翼点入路47例（翼点组）及经眶上外侧入路29例（眶外组）手术治疗的颅咽管瘤患者的临床资料。根据影像学资料对两组患者肿瘤的性质、大小、部位、有无钙化进行比较。手术中依据实际情况选择肿瘤全切或次全切除。术后1周评价患者术前相关症状的改善状况，并进行手术前后Karnofsky功能状态（KPS）评分比较。术后2周时评估患者的术后并发症。术后1个月随访进行格拉斯哥预后量表(Glasgow outcome scale,GOS）评分。结果眶外组患者的肿瘤全切率显著高于翼点组（P=0.002），术后视力视野改善（P＜0.001）及KPS评分（P=0.002）和GOS评分（P=0.002）均显著优于翼点组；并且术后视力损害和尿崩的发生率均显著低于翼点组（P＜0.001，P=0.001）。结论眶上外侧入路能够显著提高颅咽管瘤的手术全切率，改善神经损害症状，同时减少手术并发症的发生，是一种值得临床广泛推广应用的手术方式。

Abstract:

Objective To discuss the different effects and complications of the lateral supraorbital approach and the pterional approach in craniopharyngioma surgery. Methods The clinical data and preoperative KPS（Karnofsky） scores of 47 craniopharyngiomas treated by pterional approach(pterional group) and 29 craniopharyngiomas treated by supraorbital lateral approach(extraorbital group) in the First Affiliated Hospital of Soochow University from August 2012 to August 2018 were analyzed retrospectively and compared. According to the imaging data, the characteristic of the tumor(nature, size, location, presence or absence of calcification) were compared between the two groups. During the surgery, full or subtotal resection was selected according to the actual situation. One week after operation, the patients were evaluated for improvement of preoperative symptoms, and postoperative KPS（Karnofsky） scores were performed. The postoperative complications were evaluated 2 weeks after surgery and the prognosis GOS scores were followed up 1 month after operation. Results The total tumor resection rate was significantly higher in the lateral supraorbital group than in the pterional group(P=0.002), and the postoperative improvement of vision and visual field were significantly better than pterional group(P=0.000). The KPS score(P=0.002) and the GOS scores(P=0.002) were also significantly better than pterional group. The postoperative complications of visual acuity, diabetes inspidus, and infection were significantly lower in the lateral supraorbital group. Conclusion The lateral supraorbital approach surgery can significantly improve the total resection rate of craniopharyngioma, improve neurological symptoms and reduce the occurrence of postoperative complications. It is worth to be used widely in clinical practice.

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更新日期/Last Update: 2020-10-16