發(fā)布時間：2018-06-12 01:17

  本文選題：顱咽管瘤 + 手術(shù)入路��； 參考：《鄭州大學》2014年碩士論文

【摘要】：背景和目的 顱咽管瘤是良性腫瘤，起源于胚胎期Rathke囊的殘存上皮細胞。雖然為良性腫瘤，但由于腫瘤多累及下丘腦、視神經(jīng)和視交叉、垂體柄等，對鞍區(qū)上部重要神經(jīng)組織侵犯，治療效果不甚樂觀。本文經(jīng)過回顧性分析各類有差別治療顱咽管瘤的方式，觀測治療結(jié)果及并發(fā)癥等，探討顱咽管瘤最佳治療方案并對其相關(guān)影響要素進行分析。 材料和方法 回顧性分析鄭州大學第一附屬醫(yī)院2008年12月-2013年12月收治的120例顱咽管瘤患者的臨床資料，所有患者均在顯微鏡下手術(shù)治療，術(shù)后病理均證實為顱咽管瘤。對患者性別、手術(shù)前后臨床癥狀、腫瘤大小、腫瘤性質(zhì)、周圍解剖、內(nèi)分泌、影像學特點、腫瘤的切除程度、并發(fā)癥及預(yù)后等方面分析顱咽管瘤的治療策略。 結(jié)果 本組顱咽管瘤患者，兒童患者63例，歲數(shù)在5-15歲之間，平均約9歲，男33例，女30例；成年患者57例，年齡在51-73歲，平均59歲，男31例，女26例。入院時臨床主要表現(xiàn)為：視力障礙者61例，頭痛者58例，多飲多尿者15例，月經(jīng)紊亂者13例，發(fā)育矮小者20例，陽痿者8例，近期記憶喪失者6例，肢體無力者2例，動眼神經(jīng)麻痹者2例，體檢發(fā)現(xiàn)者2例。120例顱咽管瘤患者均行手術(shù)切除，腫瘤全切除者82例，次全切除者26例，部分切除者12例，回訪的82例全切病人有6例復(fù)發(fā)，占7.3%，38例次全切或部分切除患者21例行立體定向放射治療，回訪時復(fù)發(fā)者為2例，而17例未行立體定向放射治療，回訪時復(fù)發(fā)者為11例。手術(shù)方式分別采用翼點入路90例，額下入路12例，胼胝體入路8例，經(jīng)蝶入路3例，其他入路3例。根據(jù)術(shù)前影像學檢查和術(shù)中觀察發(fā)現(xiàn)，所有腫瘤中有有鈣化者61例，，占50.8%，無鈣化者59例，占49.2%；囊實性腫瘤95例，占79.2%，實性腫瘤25例，占20.8%；40例患者術(shù)前存在腦積水，占33.3%；80例患者術(shù)前未見腦積水，占66.7%。腫瘤從1cm-7cm不等，平均大小2.95士1.35cm。 結(jié)論 顯微手術(shù)是治療顱咽管瘤的首選方法，如果瘤壁與垂體柄、視神經(jīng)和視交叉、下丘腦等重要結(jié)構(gòu)粘連緊密時，主張不可強行剝離，可殘留少許瘤壁于這些結(jié)構(gòu)上，術(shù)后行立體定向放射治療為最佳方法。 顱咽管瘤切除術(shù)后并發(fā)癥發(fā)生率高，例如尿崩癥、電解質(zhì)紊亂、體溫調(diào)節(jié)障礙、垂體功能低下、上消化道出血、癲癇等，積極處理并發(fā)癥是顱咽管瘤患者生存時間、生存質(zhì)量的保證。 垂體柄是否保留可以界定對于下丘腦的損傷程度。
[Abstract]:Background and objective craniopharyngioma is a benign tumor originating from the remnant epithelial cells of the Rathke's capsule at embryonic stage. Although it is a benign tumor, most of the tumors involve the hypothalamus, optic nerve and optic chiasma, pituitary stalk and so on. In this paper, we retrospectively analyzed the different treatment methods of craniopharyngioma, observed the treatment results and complications, etc. To explore the best treatment for craniopharyngioma and analyze the related factors. Materials and methods the clinical data of 120 patients with craniopharyngioma treated in the first affiliated Hospital of Zhengzhou University from December 2008 to December 2013 were retrospectively analyzed. All the patients were treated under microscope. The postoperative pathology confirmed craniopharyngioma. Sex of patients, clinical symptoms before and after surgery, tumor size, tumor nature, peripheral anatomy, endocrine, imaging features, degree of tumor resection, Results there were 63 patients with craniopharyngioma, aged between 5 and 15 years, with an average age of 9 years (33 males and 30 females), 57 adult patients (51-73 years old). The mean age was 59 years, 31 males and 26 females. The clinical manifestations were as follows: 61 cases with visual impairment, 58 cases with headache, 15 cases with polydipsia and polyuria, 13 cases with menstrual disorder, 20 cases with stunted development, 8 cases with impotence, 6 cases with short-term memory loss and 2 cases with limb weakness. Two cases of oculomotor nerve palsy and 2 cases of craniopharyngioma were found in physical examination. 82 cases of total resection of tumor, 26 cases of subtotal resection, 12 cases of partial resection, and 6 cases of recurrence of 82 cases of total resection of craniopharyngioma were performed. Twenty-one patients were treated with stereotactic radiotherapy in 38 cases of total or partial resection, and 2 cases recurred at the time of return visit, while 17 cases did not receive stereotactic radiotherapy, and 11 cases recurred at the time of return visit. There were 90 cases with pterygoid approach, 12 cases with subfrontal approach, 8 cases with corpus callosum approach, 3 cases with transsphenoidal approach and 3 cases with other approach. According to preoperative imaging examination and intraoperative observation, 61 cases (50.8%) had calcification, 59 cases (49.2%) had no calcification, 95 cases (79.2%) had cystic tumor, 25 cases (20.8%) had hydrocephalus before operation, 25 cases had solid tumor, and 40 cases had hydrocephalus before operation. No hydrocephalus was found in 80 patients (66.7%). Conclusion Microsurgery is the first choice for the treatment of craniopharyngioma. If the tumor wall is close to the pituitary stalk, optic nerve and optic chiasma, hypothalamus and other important structures, it should not be forcibly removed. A few tumor walls can be retained on these structures. Stereotactic radiotherapy is the best method after surgery. Complications after craniopharyngioma resection are high, such as diabetes insipidus, electrolyte disorders, thermoregulation disorders, hypophysis, and hypophysis. The survival time and quality of life of the patients with craniopharyngioma are guaranteed by the upper gastrointestinal hemorrhage, epilepsy and other complications. The degree of hypothalamus injury can be defined by whether the pituitary stalk is preserved or not.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R739.4

【參考文獻】

相關(guān)期刊論文 前10條

1 姚國杰,戴芳德,馬廉亭,秦尚振,徐國政,龔杰,余澤,楊銘;顱咽管瘤全切除術(shù)后低鈉血癥的診斷及處理[J];中華神經(jīng)外科疾病研究雜志;2002年01期

2 李曉陽,龍莉玲,黃仲奎;顱咽管瘤的MRI診斷[J];實用放射學雜志;2002年07期

3 朱賢立;顱咽管瘤全切除顯微技術(shù)[J];中國臨床神經(jīng)外科雜志;2000年01期

4 趙洪洋,朱賢立,趙沃華,趙甲山,林洪;翼點入路經(jīng)終板切除鞍區(qū)腫瘤的顯微外科技術(shù)[J];中國臨床神經(jīng)外科雜志;2002年03期

5 ;Microsurgical treatment of craniopharyngiomas:report of 284 patients[J];Chinese Medical Journal;2006年19期

6 周良輔,蔣大介;改良翼點入路開顱術(shù)的應(yīng)用[J];中華神經(jīng)外科雜志;1985年02期

7 張玉琪,王忠誠;兒童顱咽管瘤與下丘腦功能損害[J];中華神經(jīng)外科雜志;2001年03期

8 鄭細良;張玉琪;;顱咽管瘤術(shù)后激素替代治療[J];中華神經(jīng)外科雜志;2006年02期

9 王益華,漆松濤;尿崩癥與垂體柄損傷的關(guān)系[J];中國微侵襲神經(jīng)外科雜志;2005年01期

10 ;好東西[J];新知客;2008年05期

本文編號：2007573