颅咽管瘤的治疗策略

发布时间：2018-06-12 01:17

本文选题：颅咽管瘤 + 手术入路　；参考：《郑州大学》2014年硕士论文

【摘要】：背景和目的颅咽管瘤是良性肿瘤，起源于胚胎期Rathke囊的残存上皮细胞。虽然为良性肿瘤，但由于肿瘤多累及下丘脑、视神经和视交叉、垂体柄等，对鞍区上部重要神经组织侵犯，治疗效果不甚乐观。本文经过回顾性分析各类有差别治疗颅咽管瘤的方式，观测治疗结果及并发症等，探讨颅咽管瘤最佳治疗方案并对其相关影响要素进行分析。材料和方法回顾性分析郑州大学第一附属医院2008年12月-2013年12月收治的120例颅咽管瘤患者的临床资料，所有患者均在显微镜下手术治疗，术后病理均证实为颅咽管瘤。对患者性别、手术前后临床症状、肿瘤大小、肿瘤性质、周围解剖、内分泌、影像学特点、肿瘤的切除程度、并发症及预后等方面分析颅咽管瘤的治疗策略。结果本组颅咽管瘤患者，儿童患者63例，岁数在5-15岁之间，平均约9岁，男33例，女30例；成年患者57例，年龄在51-73岁，平均59岁，男31例，女26例。入院时临床主要表现为：视力障碍者61例，头痛者58例，多饮多尿者15例，月经紊乱者13例，发育矮小者20例，阳痿者8例，近期记忆丧失者6例，肢体无力者2例，动眼神经麻痹者2例，体检发现者2例。120例颅咽管瘤患者均行手术切除，肿瘤全切除者82例，次全切除者26例，部分切除者12例，回访的82例全切病人有6例复发，占7.3%，38例次全切或部分切除患者21例行立体定向放射治疗，回访时复发者为2例，而17例未行立体定向放射治疗，回访时复发者为11例。手术方式分别采用翼点入路90例，额下入路12例，胼胝体入路8例，经蝶入路3例，其他入路3例。根据术前影像学检查和术中观察发现，所有肿瘤中有有钙化者61例，，占50.8%，无钙化者59例，占49.2%；囊实性肿瘤95例，占79.2%，实性肿瘤25例，占20.8%；40例患者术前存在脑积水，占33.3%；80例患者术前未见脑积水，占66.7%。肿瘤从1cm-7cm不等，平均大小2.95士1.35cm。结论显微手术是治疗颅咽管瘤的首选方法，如果瘤壁与垂体柄、视神经和视交叉、下丘脑等重要结构粘连紧密时，主张不可强行剥离，可残留少许瘤壁于这些结构上，术后行立体定向放射治疗为最佳方法。颅咽管瘤切除术后并发症发生率高，例如尿崩症、电解质紊乱、体温调节障碍、垂体功能低下、上消化道出血、癫痫等，积极处理并发症是颅咽管瘤患者生存时间、生存质量的保证。垂体柄是否保留可以界定对于下丘脑的损伤程度。
[Abstract]:Background and objective craniopharyngioma is a benign tumor originating from the remnant epithelial cells of the Rathke's capsule at embryonic stage. Although it is a benign tumor, most of the tumors involve the hypothalamus, optic nerve and optic chiasma, pituitary stalk and so on. In this paper, we retrospectively analyzed the different treatment methods of craniopharyngioma, observed the treatment results and complications, etc. To explore the best treatment for craniopharyngioma and analyze the related factors. Materials and methods the clinical data of 120 patients with craniopharyngioma treated in the first affiliated Hospital of Zhengzhou University from December 2008 to December 2013 were retrospectively analyzed. All the patients were treated under microscope. The postoperative pathology confirmed craniopharyngioma. Sex of patients, clinical symptoms before and after surgery, tumor size, tumor nature, peripheral anatomy, endocrine, imaging features, degree of tumor resection, Results there were 63 patients with craniopharyngioma, aged between 5 and 15 years, with an average age of 9 years (33 males and 30 females), 57 adult patients (51-73 years old). The mean age was 59 years, 31 males and 26 females. The clinical manifestations were as follows: 61 cases with visual impairment, 58 cases with headache, 15 cases with polydipsia and polyuria, 13 cases with menstrual disorder, 20 cases with stunted development, 8 cases with impotence, 6 cases with short-term memory loss and 2 cases with limb weakness. Two cases of oculomotor nerve palsy and 2 cases of craniopharyngioma were found in physical examination. 82 cases of total resection of tumor, 26 cases of subtotal resection, 12 cases of partial resection, and 6 cases of recurrence of 82 cases of total resection of craniopharyngioma were performed. Twenty-one patients were treated with stereotactic radiotherapy in 38 cases of total or partial resection, and 2 cases recurred at the time of return visit, while 17 cases did not receive stereotactic radiotherapy, and 11 cases recurred at the time of return visit. There were 90 cases with pterygoid approach, 12 cases with subfrontal approach, 8 cases with corpus callosum approach, 3 cases with transsphenoidal approach and 3 cases with other approach. According to preoperative imaging examination and intraoperative observation, 61 cases (50.8%) had calcification, 59 cases (49.2%) had no calcification, 95 cases (79.2%) had cystic tumor, 25 cases (20.8%) had hydrocephalus before operation, 25 cases had solid tumor, and 40 cases had hydrocephalus before operation. No hydrocephalus was found in 80 patients (66.7%). Conclusion Microsurgery is the first choice for the treatment of craniopharyngioma. If the tumor wall is close to the pituitary stalk, optic nerve and optic chiasma, hypothalamus and other important structures, it should not be forcibly removed. A few tumor walls can be retained on these structures. Stereotactic radiotherapy is the best method after surgery. Complications after craniopharyngioma resection are high, such as diabetes insipidus, electrolyte disorders, thermoregulation disorders, hypophysis, and hypophysis. The survival time and quality of life of the patients with craniopharyngioma are guaranteed by the upper gastrointestinal hemorrhage, epilepsy and other complications. The degree of hypothalamus injury can be defined by whether the pituitary stalk is preserved or not.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.4

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