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目的 探讨颅咽管瘤显微手术治疗的方法和入路。方法 回顾性分析 32例颅咽管瘤显微手术的方法、并发症和治疗结果 ,总结临床处置过程中的体会。结果 31例患者经翼点入路、1例经前胼胝体入路完成手术。经术中观察及术后CT和MRI复查证实 ,肿瘤全切除 2 6例 ,次全切除 3例 ,部分切除 2例。术后出现尿崩症 2 4例 ,高钠高氯血症 18例 ,低钠血症 5例 ,高热 11例。临床痊愈出院 12例 ,好转出院 19例 ,死亡 1例。结论 采用显微手术全切颅咽管瘤 ,效果良好 ;术前即有明显下丘脑功能损害者 ,手术风险较大 ,预后差 ;鞍区颅咽管瘤采用翼点入路是最佳选择。
Objective To explore the method and route of microsurgical treatment of craniopharyngioma. Methods Retrospective analysis of 32 cases of craniopharyngioma microsurgical methods, complications and treatment results, summarize the experience of clinical treatment. Results Twenty-one patients underwent pterional approach and one had anterior transposition of corpus callosum. The intraoperative observation and postoperative CT and MRI confirmed that the total resection of the tumor in 26 cases, subtotal resection in 3 cases, partial resection in 2 cases. There were 24 cases of diabetes insipidus, 18 cases of hyperhidrosis and hyperchloremia, 5 cases of hyponatremia and 11 cases of fever. Clinical recovery discharged in 12 cases, improved discharge in 19 cases, 1 died. Conclusion Microsurgery for craniopharyngioma resection has a good effect. Preoperative hypothalamic dysfunction is obvious, and the operation risk is high and the prognosis is poor. Craniopharyngioma in the sellar region is the best choice for the treatment of craniopharyngioma by pterional approach.