手术切除颅咽管瘤后的长期随访.docVIP

手术切除颅咽管瘤后的长期随访 作者：石祥恩 作者单位：北京三博脑科医院神经外科， 北京 100093 　　【摘要】 目的 探讨颅咽管瘤手术切除后的长期疗效。 方法 回顾性分析117例随访3年以上的颅咽管瘤术后病人的临床资料。采用翼点入路手术78例，额底纵裂入路33例，额下入路6例。对术后生活质量、多饮多尿、性功能、肿瘤复发、术后治疗，死亡原因等进行随访评价。 结果 肿瘤全切除109例，近全切除8例。术中垂体柄保留65例，垂体柄离断14例，未见垂体柄38例。恢复正常生活和工作者97例 （82.9%），生活自理9例 （7.7%），生活需要照顾5例 （4.3%），死亡6例 （5.1%），其中3例死于下丘脑功能低下，1例死于高钠血症，1例死于肝病，1例死于血液病。持续尿崩症26例 （22.0%）。肿瘤复发28例 （23.9%），复发肿瘤位于鞍内4例，鞍上10例，鞍旁9例，第三脑室内3例，外侧裂和额底2例。46例成年男性病人中有勃起和射精功能10例 （21.7%），41例成年女性病人中有正常月经及生育8例 （19.5%）。 结论 手术全切除颅咽管瘤能使大部分病人得到长期正常的生活，但术后肿瘤复发和需要激素替代治疗仍是值得关注的问题。 　　【关键词】 颅咽管瘤 神经外科手术 随访研究 　　Long term follow-up for surgical resection of craniopharyngioma 　　SHI Xiangen, WU Bin, SUN Yuming, et al. 　　Department of Neurosurgery, Beijing Sanbo Brain Hospital, Beijing 100093, China 　　Abstract: Objective To explore the long-term outcome of surgical treatment for craniopharyngioma. Methods Clinical data of 117 craniopharyngioma patients postoperatively followed-up for more than 3 years were analyzed retrospectively. The surgery was performed via pterional approach in 78 cases, via fronto-basal interhemispheric approach in 33 and subfrontal approach in 6. Follow-up outcome was evaluated in terms of the quality-of-life, polydipsia or polyuria, sexual function, tumor recurrence, postoperative therapy and cause-of-death. Results Total resection of the tumor was achieved in 109 patients and subtotal resection in 8. The pituitary stalks were preserved in 65 patients, mutilated in 14 and unidentified in 38. Ninety-seven (82.9%) patients went back to their normal life and work, 9 (7.7%) could take care of themselves in life with minor neurological or endocrinological deficits, 5 (4.3%) needed assistance for daily life. Six (5.1%) patients died, of whom 3 died of hypothalamic deficiency, 1 hypernatremia, 1 hepatopathy and 1 hematopathy. Twenty-six (22.0%) patients suffered permanent polydipsia or polyuria. Twenty-eight (23.9%) patients had tumor relapse, which located in the sellar region in 4 pati