本文選題：顱咽管瘤 + 神經(jīng)外科手術(shù)　； 參考：《重慶醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討采用神經(jīng)內(nèi)鏡擴大經(jīng)鼻入路治療顱咽管瘤的效果和安全性。方法:回顧性分析2014年11月至2016年5月重慶醫(yī)科大學附屬第一醫(yī)院神經(jīng)外科收治的32例顱咽管瘤患者的臨床資料。所有病例均行神經(jīng)內(nèi)鏡擴大經(jīng)鼻入路手術(shù)治療。分析腫瘤的切除程度,患者的視力視野改善情況、內(nèi)分泌功能變化以及手術(shù)并發(fā)癥等。結(jié)果:全切除22例(69%),近全切除8例(25%),次全切除2例(6%)。存在視力、視野損害的28例患者中,24例(86%)術(shù)后視力、視野有不同程度的改善。術(shù)后腺垂體功能低下加重或出現(xiàn)新發(fā)腺垂體功能低下17例(53%),新發(fā)尿崩癥12例(48%,12/25);13例(41%)術(shù)后出現(xiàn)嗅覺減退;3例(9%)出現(xiàn)嚴重記憶減退;腦脊液漏伴嚴重顱內(nèi)感染1例(3%);腦干出血1例(3%)。隨訪時間為4~22個月,平均(10±12)個月。隨訪期內(nèi)復(fù)查MRI均未見腫瘤復(fù)發(fā),其中1例死亡。結(jié)論:采用神經(jīng)內(nèi)鏡擴大經(jīng)鼻入路手術(shù)治療顱咽管瘤安全有效,全切除率高,手術(shù)創(chuàng)傷小;但該術(shù)式仍然可能導致或加重下丘腦-垂體軸功能的損害,因此顱咽管瘤的手術(shù)治療過程中對于神經(jīng)內(nèi)分泌功能的保護仍需持續(xù)關(guān)注。
[Abstract]:Objective: to evaluate the efficacy and safety of endoscopic extended nasal approach in the treatment of craniopharyngioma. Methods: the clinical data of 32 patients with craniopharyngioma treated in neurosurgery Department of the first affiliated Hospital of Chongqing Medical University from November 2014 to May 2016 were retrospectively analyzed. All cases were treated by endoscopic extended nasal approach. The degree of tumor resection, the improvement of visual field, the changes of endocrine function and the complications of operation were analyzed. Results: total resection was performed in 22 cases, subtotal resection in 8 cases and subtotal resection in 2 cases. Visual acuity was found in 24 of 28 patients with visual field impairment. After operation, 17 cases of adenohypophyseal hypofunction or newly developed adenohypophyseal hypopsis occurred, 12 cases of newly developed diabetes insipidus, 12 cases of diabetes insipidus, 13 cases of dysolfaction, 3 cases of dysosmia, 9 cases of dysosmia), 1 case of cerebrospinal fluid leakage with severe intracranial infection, 1 case of cerebral stem hemorrhage, 3 cases of severe intracranial infection, and 3 cases of brain stem hemorrhage. The follow-up time ranged from 4 to 22 months, with an average of 10 鹵12 months. During the follow-up period, no recurrence was found in MRI, and one case died. Conclusion: extended endoscopic nasal approach is safe and effective in the treatment of craniopharyngioma with high total resection rate and minimal surgical trauma, but it may still cause or aggravate the damage of hypothalamus-pituitary axis function. Therefore, the protection of neuroendocrine function in the surgical treatment of craniopharyngioma still needs to be paid more attention.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.41

【參考文獻】

相關(guān)期刊論文 前9條

1 陳金輝;張劍寧;劉銳;王亞明;王洪偉;于新;;累及鞍下顱咽管瘤的臨床特點及治療分析[J];中華神經(jīng)外科雜志;2016年02期

2 陳虹旭;徐建國;;第三腦室內(nèi)顱咽管瘤的研究現(xiàn)狀[J];中華神經(jīng)外科雜志;2015年09期

3 展如才;王東海;王新宇;李新鋼;;神經(jīng)內(nèi)鏡經(jīng)鼻手術(shù)簡史及多層顱底重建技術(shù)現(xiàn)狀[J];山東大學學報(醫(yī)學版);2014年11期

4 朱賢立;趙洪洋;張方成;林寧;林洪;林敏華;徐衛(wèi)明;趙沃華;項煒;;顱咽管瘤按發(fā)生位置分型和命名——附手術(shù)入路與切除方法[J];中國臨床神經(jīng)外科雜志;2013年11期

5 劉俊峰;肖群根;雷霆;;經(jīng)蝶竇入路手術(shù)切除顱咽管瘤[J];中國微侵襲神經(jīng)外科雜志;2013年06期

6 姚勇;鄧侃;張波;劉小海;康軍;魏宇魁;馮銘;幸兵;連偉;包新杰;王任直;;神經(jīng)內(nèi)鏡輔助下擴大經(jīng)鼻蝶竇入路治療鞍區(qū)非垂體腺瘤性病變[J];中國微侵襲神經(jīng)外科雜志;2013年01期

7 趙虎林;田增民;于新;趙全軍;亓樹彬;;神經(jīng)內(nèi)鏡經(jīng)鼻腔-蝶竇入路手術(shù)治療老年顱咽管瘤8例[J];中國老年學雜志;2011年09期

8 杜世偉;王任直;;經(jīng)蝶竇入路手術(shù)治療顱咽管瘤[J];中國微侵襲神經(jīng)外科雜志;2010年07期

9 張玉琪,王忠誠,馬振宇,羅世祺,甲戈,邢儉,謝堅;兒童顱咽管瘤手術(shù)治療和長期隨訪[J];中華神經(jīng)外科雜志;2005年09期

相關(guān)碩士學位論文 前1條

1 謝申浩;神經(jīng)內(nèi)鏡經(jīng)鼻蝶擴大入路顱咽管瘤切除術(shù)研究及與傳統(tǒng)經(jīng)顱入路切除術(shù)的對比分析[D];南昌大學醫(yī)學院;2015年

，

本文編號：1851214