颅咽管瘤全切除术及术后并发症的防治

目的探讨颅咽管瘤全切除术的手术方法和术后并发症的防治措施。方法24例颅咽管瘤都位于鞍区。术前准备主要包括糖皮质激素的替代疗法和癫痫的预防。手术均采取翼点入路，采用显微技术从鞍区各个手术间隙分块切除肿瘤。术后处理主要包括严密观测病人的意识、尿量和血清电解质，及时防治尿崩症、电解质紊乱等并发症，预防癫痫和糖皮质激素替代治疗。结果22例病人显微镜下肿瘤全切，2例肿瘤有少部分残余，术后无明显的神经功能障碍。16例发生了尿崩症，12例发生了电解质紊乱，6例发生了体温失衡。经过处理后，电解质紊乱和体温失衡完全纠正，13例尿崩症痊愈，3例得到了缓解。结论根据肿瘤的扩展范围以选用最合适的手术入路，以及熟悉鞍区的各个手术间隙解剖并在术中充分利用之是完成颅咽管瘤全切除术的关键。术前采用糖皮质激素的替代疗法，术后严密监测尿量和血电解质，积极处理尿崩症、电解质紊乱等并发症，可以有效降低手术死亡率。

Total Resection of Craniopharyngioma and Treatment of Post-operation Complications

Objective To investigate the method of total resection of craniopharyngioma and prevention and treatment of post-operative complications. Methods Pterion craniotomy was performed in 24 patients with craniopharyngioma which was situated in sellar region after giving glucocorticoid and anti-epilepsy drug. The tumors were removed via the 4 anatomy spaces in sellar region by employing microsurgical technique. Consciousness, urine volume, and serum electrolyte of patients were observed strictly after surgery, and complications such as diabetes insipidus, serum electrolyte disorders and epilepsy were treated in time. Results Total removal of tumors were achieved in 22 cases, and minor portion of tumors was left in 2 cases. There was not obvious deficit of nervous system function in all of the patients after surgery. Diabetes insipidus, serum electrolyte disorder and body temperature disorder occurred in 16 cases, 12 case, and 6 cases respectively. After treatment, serum electrolyte disorder and body temperature disorder were rectified in all cases, and diabetes insipidus was rectified in 13 of 16 cases. Conclusion Choosing the best operation approach according to the scope of tumor invasion and being familiar with the 4 sellar anatomy spaces were the keys to remove craniopharyngioma completely. Giving glucocorticoid before operation and active treatment of complications such as diabetes insipidus and serum electrolyte disorder could effectively decrease mortality.