内镜下经鼻入路切除颅咽管瘤（附65例报告）*

Endoscopic endonasal approach for management of craniopharyngiomas (65 cases)*

摘要:

目的??探讨内镜下经鼻入路切除颅咽管瘤的临床经验和应用价值。方法 回顾性分析2012年2月-2016年5月使用内镜下经鼻入路切除的65例颅咽管瘤患者的临床资料，综合评价治疗效果、并发症发生率及随访结果。结果 肿瘤全切52例（80.0%），次全切11例（16.9%），部分切除2例（3.1%）；术中发现垂体柄共57例，保留41例（71.9%）；术后视力改善31例（47.7%），6例维持在术前水平，1例术后视力下降；术后出现垂体功能下降21例（32.3%）；术后短暂性尿崩45例（69.2%），长期尿崩9例（13.8%）；4例（6.2%）患者出现脑脊液漏，均伴随颅内感染，均予以再次修补，成功3例，死亡1例；围手术期死亡3例（4.6%）。52例患者接受随访，时间4.0～45.0个月，平均20.8个月，44例（84.6%）恢复正常生活，8例（15.4%）出现肥胖，2例复发，尚无死亡病例。结论 内镜下经鼻入路切除颅咽管瘤安全、有效、微创，具有其独到的优势。

Abstract:

Objective?To present our experience with management of craniopharyngiomas by endoscopic endonasal approach?Methods?A retrospective review of clinical data of 65 patients who were treated for craniopharyngiomas by endoscopic endonasal approach from February 2012 to May 2016. All patients were analyzed by treatment effect, complications, and follow-up result.?Results?Total removal of the tumors were completed in 52 cases (80.0%), subtotal removal in 11 cases (16.9%), and partial resection in 2 cases (3.1%). The pituitary stalks were identified in 57 cases when surgery, and severed in 41 cases (71.9%). Postoperative visual acuity was improved in 31 cases (47.7%), and 6 cases remained in the preoperative level, whereas worsening occurred in 1 case. Worsening of the anterior pituitary function was reported in 21 cases (32.3%). Transient diabetes insipidus after operation was occurred in 45 patients (69.2%), and long-term diabetes insipidus was occurred in 9 cases (13.8%). Postoperative cerebrospinal fluid (CSF) leak was occurred in 4 cases (6.2%), accompanied with intracranial infection, and all these cases were repaired under endoscope again, 3 cases were saved, but 1 case was dead. Perioperative mortality rate was 4.6%. 52 patients were followed up for 4.0 ~ 45.0 (mean, 20.8) months, and 44 patients (84.6%) returned life to normal. Obesity developed in 8 patients (15.4%), with 2 recurrent cases and no deaths during follow-up period. ?Conclusion?The endoscopic endonasal approach is a safe and effective minimally invasive surgery approach for treating craniopharyngiomas, and has its own unique advantage.