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目的:探讨显微外科手术治疗颅咽管瘤中对下丘脑保护的治疗策略和技术。方法:2004年6月至2009年6月手术治疗颅咽管瘤39例,根据患者术前评估制定手术策略和方法,Ommaya囊植入加术后32P内放疗3例,肿瘤部分切除加术后放疗9例,肿瘤全切除术27例。对患者的临床资料、手术并发症、出院时状况、肿瘤控制情况和术后生活状况等进行总结。结果:21例获肿瘤全切除或近全切除。术后并发症包括尿崩、水电解质紊乱、视力下降等。随访29例,时间3～60个月。因肿瘤控制不佳或增大再次手术5例;恢复术前工作和学习24例,生活自理3例,生活不能自理1例,死亡1例。结论:手术前根据患者状况制定个体化的手术治疗策略,术中应用显微外科技术保护下丘脑及其穿通动脉,可以降低下丘脑损伤的发生,改善治疗效果。
Objective: To discuss the therapeutic strategies and techniques of hypothalamus protection in craniopharyngioma treated by microsurgery. Methods: From June 2004 to June 2009, 39 cases of craniopharyngioma were surgically treated. According to the preoperative evaluation, the surgical strategies and methods were developed. Three cases of Ommaya sac implantation and radiotherapy of 32P after operation were performed. Partial resection of tumor and postoperative Radiotherapy in 9 cases, tumor resection in 27 cases. The clinical data of patients, surgical complications, discharge status, tumor control and postoperative living conditions were summarized. Results: Twenty-one patients underwent total or near total tumor resection. Postoperative complications include insipidus, water and electrolyte disorders, decreased vision and so on. Follow-up 29 cases, time 3 to 60 months. Due to poor tumor control or increased reoperation in 5 cases; restoration of preoperative work and learning 24 cases, living in 3 cases, life can not take care of 1 case, 1 case of death. Conclusions: According to the condition of the patient before operation, the individualized surgical treatment strategy is formulated. The intraoperative use of microsurgical techniques to protect the hypothalamus and its penetrating artery can reduce the incidence of hypothalamic injury and improve the therapeutic effect.