颅咽管瘤的显微外科治疗.docVIP

颅咽管瘤的显微外科治疗 阿里木江.克里木，穆合塔尔.卡德尔，杨小朋，郑勇，阿不都克尤木，李津生，董军，刘伟，*徐宇伦 (新疆维吾尔自治区人民医院神经外科，新疆乌鲁木齐830001) 摘要 目的 探讨鞍区颅咽管瘤的显微手术入路的选择及并发症的防治措施。方法 对32例颅咽管瘤病人采用不同的手术方式切除肿瘤。其中，24例患者经翼点入路，8例经胼胝体入路完成手术，结果 经术中观察及术后CT和MRI复查证实，肿瘤全切除26例，次全切除3例，部分切除3例。术后出现尿崩症12例，高钠高氯血症17例，低钠血症2例，高热l例。临床痊愈出院22例，好转出院9例，死亡1例。结论 采用鞍区颅咽管瘤，选择合适的手术入路，并重视术中对下丘脑的保护，是降低术后并发症的重要环节。 关键词 颅咽管瘤；显微手术；手术入路 Microsurgical resection of craniopharyngionmas ALimu Yangxiaopeng Zhenyong Lijingsheng Dongjun Abudukeyoumu．etal．Depa~ment of Neurosurgery,Xinjiang People’S Hospital，Wulumuqi China 830001． Abstrack Objective To investigate the method and approach of microsurgical resection of cranipharyngiomas．explore the preventive and therapeutic strategies for surgical complications．Methods The clinical data of 3 2 cases among the patients with craniopharyngiomas，who were hospitalized in our department from January,2003 to June，2009，were analyzed retrospectively．Results The opermion was performed via a pterionl approach in 24 cases and a transcallosal approach in 8 case．Major postoperative comlications included diabetes insipidus in 12 cases and electrolyte disturbance in 19．The tumor removal was considered total in 26 cases，subtotal in 3 cases，and partial in 3 cases．12 cases were suffered from diabetes，12 cases from hypematremia and hyperchloraemia，2 cases from hyperpyrexia，and 1 cases from hyperpyrexia after operations．Twelve cases recovered clinically, 19 cases improved，and l case died．Conclusion Choosing appropriate approaches is helpful to directly expose and totally remove the craniopharyngioma．Skilled microsurgical techniques，acquaintance with the anatomy in the saddle area and protecting hypothalamus from injury are the keys for preventing postoperative complications． Key words：Craniopharyngiomas；Microsurgery；Operative approach 颅咽管瘤是常见鞍区良性肿瘤，与视神经、视交叉、垂体柄、漏斗、Willis氏血管环等重要结构紧邻或与之发生粘连，因此手术致残和并发症较高，体积较大者可压迫这些结构，由于肿瘤的生长方式组织内部和邻近结构的复杂性，我院实施不同的手术入路。我院自2004年1月至2010年1月对收治的颅咽管瘤患者中的32例根据肿瘤生长方式及发展方向实施了不同的显微手术入路，现报告如下。 临床资料与方法