本文選題：顱咽管瘤 + 垂體柄　； 參考：《中南大學》2014年博士論文

【摘要】：目的： 本文擬通過回顧性分析203例接受顱咽管瘤手術患者的資料,同時通過長期的隨訪,觀察垂體柄保留和切除的患者復發(fā)率和內分泌功能上的差異,探討術中對垂體柄切除和保留的標準,總結顱咽管瘤手術中對垂體柄的處理原則。 方法： 我們回顧性分析了過去20年由同一教授連續(xù)主刀完成的203例顱咽管瘤患者,對患者的腫瘤起源進行了記錄,對術中垂體柄的保留與切除情況進行了記錄。其中,從2010年開始,將術中認為被腫瘤侵犯的垂體柄進行電鏡檢測,觀察是否存在腫瘤細胞。同時對患者進行了長期隨訪,記錄腫瘤是否復發(fā),術后患者內分泌情況、視力視野情況以及患者生存質量情況。對垂體柄切除和保留的患者進行復發(fā)率和內分泌功能的比較。 結果： 203例顱咽管瘤患者,175人獲得全切除(175/203,86.2%),2828人獲得次全切除(28/203,13.8%).在所有203例病人中,25例病人失訪,不納入分析,四例圍手術期死亡病人(4/203,1.97%),其余174名患者接受隨訪。全切除組的157名患者復發(fā)14名(14/157,8.9%),次全切除組的21名患者腫瘤再生長7名(7/21,33.3%),兩者在腫瘤進展上有顯著性差異。本組患者5年PFS為84.2%。203例患者中,165例起源于垂體柄,36例起源于鞍內,2例異位起源。垂體柄保留的患者34例(34/203,16.7%)。選取全切的且接受隨訪的157例患者進行分析,垂體柄保留的患者復發(fā)率(4/34,11.8%)與垂體柄切除(10/123,8.1%)的患者復發(fā)率無差異�？紤]到起源的影響,選取這157例患者中起源于垂體柄的128例患者進行研究,垂體柄保留的患者復發(fā)率(1/19,5.3%)與垂體柄切除(6/109,5.5%)的患者復發(fā)率同樣無差異。在有內分泌資料的91人中,垂體柄保留組的內分泌功能正常、較好、較差的人數分別是(5,18,0),而垂體柄切除組的內分泌功能正常、較好、較差的人數分別是(1,60,7),有統(tǒng)計學差異。在尿崩發(fā)生率上,垂體柄保留組的發(fā)生率為(5/31,16.1%),垂體柄切除組的發(fā)生率為(44/118,37.3%),兩者有差異性。 術中切除的垂體柄15例,進行電鏡超微觀察,15例均發(fā)現腫瘤細胞和垂體柄特有結構。 結論： 1.行手術全切除腫瘤是治療顱咽管瘤的有效手段。 2.顱咽管瘤手術應盡可能全切除腫瘤,獲得全切除的患者生存時間長于未全切除患者,且腫瘤進展風險小于未全切患者,再次手術的患者腫瘤復發(fā)進展的風險高于原發(fā)腫瘤的患者。 3.顱咽管瘤手術中對于垂體柄的處理應遵循一定的標準,本文提出的基本標準有效,但仍需更多驗證。 4.對于起源于垂體柄的顱咽管瘤,嚴格把握垂體柄切除的標準,保留沒有被腫瘤侵犯的垂體柄并不增加患者復發(fā)的風險,且對于患者垂體前葉的功能保留和術后的內分泌功能有重要的意義。
[Abstract]:Objective: to retrospectively analyze the data of 203 patients undergoing craniopharyngioma surgery, and to observe the difference of recurrence rate and endocrine function in patients with pituitary stalk preservation and resection through long-term follow-up. To discuss the standard of resection and preservation of pituitary stalk during operation, and summarize the principle of management of pituitary stalk in craniopharyngioma. Methods: we retrospectively analyzed 203 patients with craniopharyngioma who had been performed by the same professor for the past 20 years. The origin of the tumor was recorded and the preservation and excision of the pituitary stalk during the operation were recorded. From 2010 onwards, the pituitary stalk which was believed to have been invaded by tumor was examined by electron microscope to observe whether there were tumor cells. At the same time, the patients were followed up for a long time to record the recurrence, endocrine status, visual field and quality of life. The recurrence rate and endocrine function of patients with pituitary stalk resection and preservation were compared. Results: of the 203 patients with craniopharyngioma, 175 received total resection. Out of 203 cases, 25 cases were not included in the analysis. Four patients died during perioperative period and 4 / 203 / 1.97%. The remaining 174 patients were followed up. There was a significant difference in tumor progression between 157 patients in the total resection group and 21 patients in the subtotal resection group. There was a significant difference in tumor progression between 14 / 157 patients (14 / 157 / 8.9) and 7 patients (7 / 21 / 33. 33.3) in the subtotal resection group. In this group, the PFS in 5 years was 84.2% and 203 cases. 165 cases originated from pituitary stalk in 36 cases from 2 cases of heterotopic origin. There were 34 patients with pituitary stalk preservation. According to the analysis of 157 patients who were followed up, the recurrence rate of patients with pituitary stalk preservation was 4 / 34 / 11.8) and the recurrence rate of pituitary stalk resected by 10 / 123 / 8 ~ (1) was not different from that of 10 / 12 / 123 / 8 ~ (1) of pituitary stalk resection. Considering the influence of the origin, 128 of the 157 patients with pituitary stalk were studied. The recurrence rate of the patients with pituitary stalk was 1 / 19 / 5. 3) and that of the patients with pituitary stalk resection was 6 / 10 9 / 5. 5) there was no significant difference in the recurrence rate between the patients with pituitary stalk reservation and those with pituitary stalk resection (10 / 10 9 / 5. 5). In 91 people with endocrine data, the endocrine function of pituitary stalk retention group was normal, better, and the inferior group was 50.180%, while the endocrine function of pituitary stalk resected group was normal, better, and the worse group was 607m (P < 0.05). In the incidence of urinary avalanche, the incidence of pituitary stalk retention group was 5 / 31 / 16.1%, and that of pituitary stalk resection group was 44% 1180.37. 3%, there was a difference between the two groups. 15 cases of pituitary stalk were resected during operation, 15 cases were observed by electron microscope and 15 cases were found to have special structure of tumor cell and pituitary stalk. Conclusion: 1. Total resection of tumors is an effective treatment for craniopharyngioma. 2. In craniopharyngioma surgery, the tumor should be removed as completely as possible. The survival time of the patients with total resection is longer than that of the patients without total resection, and the risk of tumor progression is lower than that of the patients without total resection. The risk of tumor recurrence and progression in patients undergoing reoperation was higher than that in patients with primary tumors. The treatment of pituitary stalk in craniopharyngioma operation should follow certain standard. The basic standard proposed in this paper is effective, but it still needs more verification. 4. In the case of craniopharyngioma originating from the pituitary stalk, the criteria for resection of the pituitary stalk are strictly adhered to, and the preservation of the pituitary stalk that is not invaded by the tumor does not increase the risk of recurrence. It is of great significance for the preservation of anterior pituitary function and the endocrine function after operation.
【學位授予單位】：中南大學
【學位級別】：博士
【學位授予年份】：2014
【分類號】：R739.41

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