152例成人颅咽管瘤临床治疗分析

发布时间：2018-03-01 07:37

本文关键词： 颅咽管瘤全切除复发率并发症尿崩症　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:颅咽管瘤是鞍区常见的先天性良性肿瘤,沿胚胎颅咽管的发生路径生长。虽为良性肿瘤,但由于具有侵袭性生长的特点,与垂体柄、Willis环、视交叉、下丘脑等重要神经血管组织关系密切,手术全切除难度大,术后并发症多,治疗效果不甚满意。本文通过对152例成人颅咽管瘤的临床治疗进行回顾性分析,探讨成人颅咽管瘤的最佳治疗策略、影响尿崩症发生的相关因素以及术后常见并发症的处理。对象和方法:通过对郑州大学第一附属医院神经外科自2009年2月~2016年11月收治的152例成人颅咽管瘤的临床治疗进行回顾性分析,对肿瘤切除程度及应用伽马刀放射治疗与复发率的关系、原发和复发颅咽管瘤全切率的对比以及肿瘤切除术后常见并发症尿崩症发生的影响因素(性别、肿瘤大小、泌乳素升高、术中垂体柄是否保留等)进行统计学分析,去探讨成人颅咽管瘤的最佳治疗策略、影响尿崩症发生的相关因素,并对常见并发症的处理进行了阐述。结果:本组152例中得到随访的有134例,目前能正常学习、生活者108例(截止随访期),需要长期照料、生活不能自理者16例,死亡10例。152例中,原发性颅咽管瘤131例,复发颅咽管瘤21例。其中男性88例,女性64例,男女比例约1.4:1;发病年龄从18岁~70岁不等,平均发病年龄44.4±13.6岁;病程7天~10年不等,平均病程9.77月。手术方式采用常规翼点或扩大翼点入路51例,额下入路28例,前额纵裂入路42例,经鼻蝶入路13例(神经内镜4例),前额胼胝体-透明隔间隙-穹窿间入路10例,翼点及胼胝体联合入路6例,皮层造瘘入路2例。其中98例全切除,39例次全切除,大部分切除者15例;复发颅咽管瘤21例中,全切除6例,次全切除6例,大部分切除9例。随访时间3个月~93个月不等,中位随访时间为61个月。在随访134例中,87例全切病人均(术后未行放射治疗),有13例复发;47例近全切或大部分切除患者中27例行立体定向放射外科(外院行伽马刀放射治疗),复发5例,20例未行放射治疗等辅助治疗措施,复发13例。结论:1.成人颅咽管瘤的首选治疗方法是显微外科手术,对于手术中难以全切除的瘤体不可过分追求全切,术后辅以伽马刀放射治疗仍然可取得满意的疗效。2.肿瘤全切除、术前出现尿崩症状、术中垂体柄保留不明确或未保留、术前泌乳素升高、肿瘤最大径大于等于3cm可能增加术后尿崩症的发生率。3.颅咽管瘤手术后并发症常见,积极处理各种并发症是安全度过围手术期的关键所在。
[Abstract]:Objective: craniopharyngioma is a common congenital benign tumor in the Sellar region. The relationship between hypothalamus and other important neurovascular tissues is close, total resection is difficult, postoperative complications are many, and the therapeutic effect is not satisfactory. The clinical treatment of 152 cases of adult craniopharyngioma was analyzed retrospectively. To explore the best treatment strategy of craniopharyngioma in adults. Factors affecting the occurrence of diabetes insipidus and management of common postoperative complications. Objects and methods: from February 2009 to November 2016, 152 cases of adult craniopharyngioma were treated in neurosurgery department of the first affiliated hospital of Zhengzhou university from February 2009 to November 2016. The bed therapy was analyzed retrospectively. The relationship between tumor resection degree, gamma knife radiotherapy and recurrence rate, the comparison of total resection rate between primary and recurrent craniopharyngioma, and the influencing factors (sex, tumor size) of diabetes insipidus, common complications after tumor resection, were analyzed. To explore the best treatment strategy of adult craniopharyngioma and the related factors of diabetes insipidus. The treatment of common complications was discussed. Results: 134 cases were followed up in 152 cases, 108 cases were able to learn normally and 108 cases lived (by the end of the follow-up period, 16 cases needed long-term care, 16 cases could not take care of themselves). There were 131 cases of primary craniopharyngioma and 21 cases of recurrent craniopharyngioma, of which 88 cases were male and 64 cases were female, the ratio of male to female was about 1.4: 1.The age of onset ranged from 18 years to 70 years, the mean age of onset was 44.4 卤13.6 years, the course of disease ranged from 7 days to 10 years. The mean course of disease was 9.77 months. 51 cases underwent conventional pterional or extended pterygoid approach, 28 cases underwent subfrontal approach, 42 cases underwent frontal fissure approach. Transsphenoidal approach was performed in 13 cases (neuroendoscopy in 4 cases, prefrontal corpus callosum, septum pellucida interfornix approach in 10 cases, combined pterional and corpus callosum approach in 6 cases, and cortical fistula approach in 2 cases). Among 21 cases of recurrent craniopharyngioma, 6 cases were totally resected, 6 cases were subtotal resection, 9 cases were mostly resected. The follow-up time ranged from 3 months to 93 months. The median follow-up time was 61 months. Of 134 cases followed up, 87 cases underwent total resection (no postoperative radiotherapy was performed), 13 cases of recurrence 47 cases of near-total or most resected patients 27 cases of stereotactic radiosurgery. In 5 cases of recurrence, 20 cases did not receive radiotherapy and other adjuvant treatment measures. Conclusion 1. The preferred treatment for adult craniopharyngioma is microsurgery. Total resection of tumor, diabetes insipidus before operation, unclear or unreserved pituitary stalk during operation, prolactin increase before operation, postoperative gamma knife radiotherapy can still obtain satisfactory curative effect .2.The tumor was completely resected, diabetes insipidus appeared before operation, pituitary stalk was not clear or not retained during operation, prolactin increased before operation. The incidence of diabetes insipidus may be increased by the maximum diameter of tumor being greater than or equal to 3 cm. Complications after craniopharyngioma surgery are common. Active management of various complications is the key to the safe passage of perioperative period.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.41

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