颅咽管瘤显微外科治疗的远期疗效及影响因素分析（附177例报告）

发布时间：2019-03-11 11:59

【摘要】：目的：颅咽管瘤最佳治疗的方式仍是一个颇具争议的问题。本研究回顾性分析了袁贤瑞教授自2003年至2013年9月间担任主刀的177例颅咽管瘤患者的临床资料,初步探讨颅咽管瘤最佳的治疗方案,分析影响颅咽管瘤预后的因素,对进一步提高颅咽管瘤的治疗效果,降低死残率,提高患者生存质量具有重要意义。 方法：收集中南大学湘雅医院袁贤瑞教授自2003年至2013年9月间担任主刀的177例颅咽管瘤的出入院资料,并对患者进行跟踪随访,了解患者的生存状态,采用MRI评估肿瘤复发情况,从神经功能、视力、垂体功能、下丘脑功能、生活工作情况等方面评价患者的生存质量,采用颅咽管瘤临床状态量表予以分级并赋值,运用统计分析结合临床观察分析影响预后的因素。 结果：术者于2003年2月至2013年9月共为177名患者行185次手术,病例组包括原发性颅咽管瘤162例,复发颅咽管瘤21例,2例行二期手术。169例(91.35%)采用单侧经额下入路,167例患者获得肿瘤全切除,肿瘤全切率达94.35%,围术期死亡3例(1.7%)。本研究截止时共随访患者161名,随访平均时间47.23月,随访期死亡患者21名,总死亡率14.9%,10年存活率85.1%,复发20例(12.7%),5年PFS率80%。截止随访能维持工作学习,完成日常事务生活自理(Wen氏Ⅰ-Ⅱ级)的患者占最终随访人群的86.7%。肿瘤未全切除和肿瘤累及三脑室是影响患者术后生存的危险因素；肿瘤未全切除,肿瘤起源于鞍内是肿瘤进展的危险因素。 结论：1.全切除肿瘤远期生存率良好,复发率低,功能状态良好。 2.单侧额下入路结合视交叉前间隙、视神经-颈内动脉间隙、终板入路能安全地全切除大部分类型肿瘤。 3.肿瘤未全切除、肿瘤累及三脑室是影响患者术后生存的危险因素；复发颅咽管瘤、肿瘤未全切除、肿瘤起源于鞍内是肿瘤进展的危险因素。 4.术后妥善管理,疾病知识教育和规律随访对降低总体死亡率,改善患者生活质量具重要意义。
[Abstract]:Objective: the optimal treatment of craniopharyngioma is still a controversial issue. In this study, the clinical data of 177 patients with craniopharyngioma from 2003 to September 2013 were retrospectively analyzed, and the optimal treatment of craniopharyngioma was preliminarily discussed, and the factors affecting the prognosis of craniopharyngioma were analyzed. It is of great significance to further improve the therapeutic effect of craniopharyngioma, reduce the rate of death and disability, and improve the quality of life of the patients. Methods: the data of 177 cases of craniopharyngioma admitted by Professor Yuan Xianrui, Xiangya Hospital, Central South University from 2003 to September 2013 were collected, and the patients were followed up to understand the survival status of the patients. The recurrence of tumor was evaluated by MRI. The quality of life of the patients was evaluated by neurologic function, visual acuity, pituitary function, hypothalamus function and living and working condition, and the clinical status scale for craniopharyngioma was used to grade and evaluate the quality of life of the patients. Statistical analysis combined with clinical observation was used to analyze the prognostic factors. Results: between February 2003 and September 2013, 177 patients underwent 185 operations, including 162 cases of primary craniopharyngioma, 21 cases of recurrent craniopharyngioma, 2 cases of secondary operation, 169 cases (91.35%) of them underwent unilateral transfrontal approach. The total resection rate was 94.35% and the perioperative death rate was 1.7% (3 / 167). A total of 161 patients were followed up at the end of the study. The mean follow-up time was 47.23 months. 21 patients died during the follow-up period, with a total mortality rate of 14.9%, a 10-year survival rate of 85.1%, a recurrence rate of 20 cases (12.7%), and a 5-year PFS rate of 80%. At the end of follow-up, 86.7% of the final follow-up patients were able to maintain work-study and complete their daily life (Wen grade 鈪，

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