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目的探讨大型(直径大于40mm)颅咽管瘤切除术后并发症的发生情况和有效的防治方法。方法40例大型颅咽管瘤患者中20例经翼点入路,11例经眶上眉弓锁孔入路,6例经纵裂穹隆间入路,3例经前纵裂终板入路,经鞍区不同解剖间隙切除肿瘤。术中注意保护来自颈内动脉、前后交通动脉和脉络膜前动脉供应下丘脑的穿动脉。肿瘤囊液放出后分块切除实体肿瘤部分。结果36例全切除;1例次全切除,侧脑室钙化囊壁残留,长期无特殊变化;1例鞍内、2例鞍旁残留均加行放射治疗。术后早期26例出现尿崩,33例出现不同程度钠、氯、钾、镁、钙等电解质紊乱,2例出现高热及术后早期意识恢复不佳,6例视力下降加重,均经积极治疗后好转。36例术后不同时间参加日常工作,2例需要生活照顾,2例死亡。结论术前良好准备,精心设计手术入路,保证良好视野和照明,术中直视下尽可能多锐性解剖,保护垂体柄、下丘脑及其小的穿支血管,术后立即监测水电解质的变化对防治大型颅咽管瘤术后并发症具有重要价值。
Objective To investigate the incidence of complications and effective methods of prevention and treatment of large (more than 40mm in diameter) craniopharyngioma resection. Methods Twenty cases of 40 cases of large craniopharyngioma were treated with pterional approach, 11 cases with supraorbital eyebrow keyhole approach, 6 cases with longitudinal fissure approach and 3 cases with anterior longitudinal cleft endplate approach After resection of tumors by different anatomical spaces in the saddle area. Intraoperative attention to protection from the internal carotid artery, anterior and posterior communicating artery and choroidal anterior artery hypothalamic artery supply. After the tumor cystic fluid release block removal of solid tumor part. Results 36 cases were totally resected; 1 case was subtotally resected and the calcified cystic wall remained in the lateral ventricle. There was no special change in the long term. Radiotherapy was performed in 1 case of the saddle and 2 cases of parasellar residue. In the early postoperative period, there were diastolic blood pressure in 26 cases, electrolyte imbalance of sodium, chloride, potassium, magnesium and calcium in 33 cases, high fever in 2 cases and poor recovery in the early postoperative period, and decreased visual acuity in 6 cases. After the improvement. Thirty-six patients took part in their daily work at different times, two needed life care and two died. Conclusions Good preoperative preparation, meticulous design of surgical approach to ensure good vision and illumination, intraoperative as much as possible sharp anatomy under direct vision to protect the pituitary stalk, the hypothalamus and its small perforator blood vessels, immediately after monitoring the water and electrolyte Changes in the prevention and treatment of large craniopharyngioma postoperative complications of great value.