神经内镜扩大经鼻入路治疗颅咽管瘤的临床分析

发布时间：2018-05-06 06:34

本文选题：颅咽管瘤 + 神经外科手术　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的:探讨采用神经内镜扩大经鼻入路治疗颅咽管瘤的效果和安全性。方法:回顾性分析2014年11月至2016年5月重庆医科大学附属第一医院神经外科收治的32例颅咽管瘤患者的临床资料。所有病例均行神经内镜扩大经鼻入路手术治疗。分析肿瘤的切除程度,患者的视力视野改善情况、内分泌功能变化以及手术并发症等。结果:全切除22例(69%),近全切除8例(25%),次全切除2例(6%)。存在视力、视野损害的28例患者中,24例(86%)术后视力、视野有不同程度的改善。术后腺垂体功能低下加重或出现新发腺垂体功能低下17例(53%),新发尿崩症12例(48%,12/25);13例(41%)术后出现嗅觉减退;3例(9%)出现严重记忆减退;脑脊液漏伴严重颅内感染1例(3%);脑干出血1例(3%)。随访时间为4~22个月,平均(10±12)个月。随访期内复查MRI均未见肿瘤复发,其中1例死亡。结论:采用神经内镜扩大经鼻入路手术治疗颅咽管瘤安全有效,全切除率高,手术创伤小;但该术式仍然可能导致或加重下丘脑-垂体轴功能的损害,因此颅咽管瘤的手术治疗过程中对于神经内分泌功能的保护仍需持续关注。
[Abstract]:Objective: to evaluate the efficacy and safety of endoscopic extended nasal approach in the treatment of craniopharyngioma. Methods: the clinical data of 32 patients with craniopharyngioma treated in neurosurgery Department of the first affiliated Hospital of Chongqing Medical University from November 2014 to May 2016 were retrospectively analyzed. All cases were treated by endoscopic extended nasal approach. The degree of tumor resection, the improvement of visual field, the changes of endocrine function and the complications of operation were analyzed. Results: total resection was performed in 22 cases, subtotal resection in 8 cases and subtotal resection in 2 cases. Visual acuity was found in 24 of 28 patients with visual field impairment. After operation, 17 cases of adenohypophyseal hypofunction or newly developed adenohypophyseal hypopsis occurred, 12 cases of newly developed diabetes insipidus, 12 cases of diabetes insipidus, 13 cases of dysolfaction, 3 cases of dysosmia, 9 cases of dysosmia), 1 case of cerebrospinal fluid leakage with severe intracranial infection, 1 case of cerebral stem hemorrhage, 3 cases of severe intracranial infection, and 3 cases of brain stem hemorrhage. The follow-up time ranged from 4 to 22 months, with an average of 10 卤12 months. During the follow-up period, no recurrence was found in MRI, and one case died. Conclusion: extended endoscopic nasal approach is safe and effective in the treatment of craniopharyngioma with high total resection rate and minimal surgical trauma, but it may still cause or aggravate the damage of hypothalamus-pituitary axis function. Therefore, the protection of neuroendocrine function in the surgical treatment of craniopharyngioma still needs to be paid more attention.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.41

【参考文献】