【摘要】
目的：探讨颅咽管瘤手术入路的选择及手术疗效。
方法：收集2007年12月至 2014年8月手术治疗颅咽管瘤371例，采用额下翼点入路167例、经额部纵裂入路和经终板入路93例、经前部胼胝体-透明隔间隙-穹窿间入路74例、经鼻蝶入路37例。
结果：肿瘤全切除256例，近全切除82例，部分切除33例。术后颅内压增高症状均得到缓解；131例术前月经改变、性功能减退患者中改善52例，214例视力、视野障碍患者中152例缓解。术后发生钠代谢紊乱334例、尿崩症241例、高热123例、同侧动眼神经瘫痪12例、意识障碍89例、癫痫23例(经药物治疗后均控制良好)。肿瘤复发35例，经伽玛刀治疗，效果良好。
结论:术前依据肿瘤的分型选择合适的入路，术中保护好垂体柄、下丘脑及其周围重要神经结构，术后积极处理并发症，对提高患者的生存质量至关重要。
关键词：颅咽管瘤，显微手术，手术入路，疗效



Microsurgery for craniopharyngioma: Retrospective analysis of 371 cases

Wang Yuelong, Liu Zhiyong, Yang Jinlong, Li Gaowei, Zhou Liangxue, Cai Bowen, You Chao, Xu Jianguo
【Abstract】
Objective: To explore the surgical approach of craniopharyngioma and the effect of operation.
Methods: From December 2007 to August 2014, 371 cases of craniopharyngioma were treated surgically. 167 cases of subfrontal in combination with the pterional approach were used, and 93 cases were treated by unifrontal basal interhemispheric approach. Transcallosal approach 74 cases, and 37 cases of transsphenoidal approach.
Results: 256 cases of total resection of tumor, 82 cases of subtotal resection, partial resection in 33 cases. Postoperative intracranial pressure increased symptoms were relieved; 120 cases of preoperative endocrine abnormalities in 52 cases improved; 191 cases of visual impairment in 152 patients with remission. There were 334 cases of sodium metabolism disorder, 241 cases of diabetes insipidus, 123 cases of hyperthermia, 12 cases of ipsilateral oculomotor nerve palsy, 89 cases of disturbance of consciousness and 23 cases of epilepsy (all controlled by drug treatment). Thirty-five recurrence tumors were well treated with gamma knife.
Conclusion: The appropriate approach is selected according to the classification of tumor before operation. The intraoperative protection of pituitary stalk, hypothalamus and its surrounding important nerve structure, postoperative treatment of complications, to improve the quality of life of patients is essential.
Key words: craniopharyngioma, microsurgery, surgical approach, treatment effect
颅咽管瘤为起源于垂体胚胎发育过程中颅颊囊残存的鳞状上皮细胞肿瘤，组织学行为表现为良性，但是由于其容易与垂体柄、视神经和下丘脑等重要神经血管粘连紧密，手术全切十分困难，术后复发率高[1]。从Halstead在1909年开展第一例颅咽管瘤手术至今，经过了近百年的发展，颅咽管瘤的手术治疗仍然是对每个神经外科医师的最大挑战[2]。四川大学华西医院从2007年12月至 2014年8月手术治疗颅咽管瘤371例，现总结如下。
1 对象与方法
1.1一般资料
本组男性211例，女性160例，男女比例1.31:1；年龄 1-72 岁，平均 33.7岁，中位年龄34岁，年龄分布呈双峰分布（图1A）；病程3个月-5年。主要症状包括头痛256例，视力下降214例，发育障碍65例，多饮多尿60例，月经改变76例，性功能减退55例，记忆力减退20例，精神障碍15例（图1B）。初次手术 322例，复发后再次手术49例。
作者：王跃龙，刘志勇，杨金龙，李高伟，周良学，姜曙，蔡博文，游潮，徐建国