發(fā)布時(shí)間：2019-03-11 11:59

【摘要】：目的：顱咽管瘤最佳治療的方式仍是一個(gè)頗具爭(zhēng)議的問(wèn)題。本研究回顧性分析了袁賢瑞教授自2003年至2013年9月間擔(dān)任主刀的177例顱咽管瘤患者的臨床資料,初步探討顱咽管瘤最佳的治療方案,分析影響顱咽管瘤預(yù)后的因素,對(duì)進(jìn)一步提高顱咽管瘤的治療效果,降低死殘率,提高患者生存質(zhì)量具有重要意義。 方法：收集中南大學(xué)湘雅醫(yī)院袁賢瑞教授自2003年至2013年9月間擔(dān)任主刀的177例顱咽管瘤的出入院資料,并對(duì)患者進(jìn)行跟蹤隨訪,了解患者的生存狀態(tài),采用MRI評(píng)估腫瘤復(fù)發(fā)情況,從神經(jīng)功能、視力、垂體功能、下丘腦功能、生活工作情況等方面評(píng)價(jià)患者的生存質(zhì)量,采用顱咽管瘤臨床狀態(tài)量表予以分級(jí)并賦值,運(yùn)用統(tǒng)計(jì)分析結(jié)合臨床觀察分析影響預(yù)后的因素。 結(jié)果：術(shù)者于2003年2月至2013年9月共為177名患者行185次手術(shù),病例組包括原發(fā)性顱咽管瘤162例,復(fù)發(fā)顱咽管瘤21例,2例行二期手術(shù)。169例(91.35%)采用單側(cè)經(jīng)額下入路,167例患者獲得腫瘤全切除,腫瘤全切率達(dá)94.35%,圍術(shù)期死亡3例(1.7%)。本研究截止時(shí)共隨訪患者161名,隨訪平均時(shí)間47.23月,隨訪期死亡患者21名,總死亡率14.9%,10年存活率85.1%,復(fù)發(fā)20例(12.7%),5年P(guān)FS率80%。截止隨訪能維持工作學(xué)習(xí),完成日常事務(wù)生活自理(Wen氏Ⅰ-Ⅱ級(jí))的患者占最終隨訪人群的86.7%。腫瘤未全切除和腫瘤累及三腦室是影響患者術(shù)后生存的危險(xiǎn)因素；腫瘤未全切除,腫瘤起源于鞍內(nèi)是腫瘤進(jìn)展的危險(xiǎn)因素。 結(jié)論：1.全切除腫瘤遠(yuǎn)期生存率良好,復(fù)發(fā)率低,功能狀態(tài)良好。 2.單側(cè)額下入路結(jié)合視交叉前間隙、視神經(jīng)-頸內(nèi)動(dòng)脈間隙、終板入路能安全地全切除大部分類型腫瘤。 3.腫瘤未全切除、腫瘤累及三腦室是影響患者術(shù)后生存的危險(xiǎn)因素；復(fù)發(fā)顱咽管瘤、腫瘤未全切除、腫瘤起源于鞍內(nèi)是腫瘤進(jìn)展的危險(xiǎn)因素。 4.術(shù)后妥善管理,疾病知識(shí)教育和規(guī)律隨訪對(duì)降低總體死亡率,改善患者生活質(zhì)量具重要意義。
[Abstract]:Objective: the optimal treatment of craniopharyngioma is still a controversial issue. In this study, the clinical data of 177 patients with craniopharyngioma from 2003 to September 2013 were retrospectively analyzed, and the optimal treatment of craniopharyngioma was preliminarily discussed, and the factors affecting the prognosis of craniopharyngioma were analyzed. It is of great significance to further improve the therapeutic effect of craniopharyngioma, reduce the rate of death and disability, and improve the quality of life of the patients. Methods: the data of 177 cases of craniopharyngioma admitted by Professor Yuan Xianrui, Xiangya Hospital, Central South University from 2003 to September 2013 were collected, and the patients were followed up to understand the survival status of the patients. The recurrence of tumor was evaluated by MRI. The quality of life of the patients was evaluated by neurologic function, visual acuity, pituitary function, hypothalamus function and living and working condition, and the clinical status scale for craniopharyngioma was used to grade and evaluate the quality of life of the patients. Statistical analysis combined with clinical observation was used to analyze the prognostic factors. Results: between February 2003 and September 2013, 177 patients underwent 185 operations, including 162 cases of primary craniopharyngioma, 21 cases of recurrent craniopharyngioma, 2 cases of secondary operation, 169 cases (91.35%) of them underwent unilateral transfrontal approach. The total resection rate was 94.35% and the perioperative death rate was 1.7% (3 / 167). A total of 161 patients were followed up at the end of the study. The mean follow-up time was 47.23 months. 21 patients died during the follow-up period, with a total mortality rate of 14.9%, a 10-year survival rate of 85.1%, a recurrence rate of 20 cases (12.7%), and a 5-year PFS rate of 80%. At the end of follow-up, 86.7% of the final follow-up patients were able to maintain work-study and complete their daily life (Wen grade 鈪，

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