颅咽管瘤的个体化治疗分析

目的 探讨颅咽管瘤个体化治疗方法以及不同治疗方法的适应症。方法 2011~2013年收治颅咽管瘤83例，首次发病者行手术切除，不能耐受开颅手术者行立体定向囊液抽吸+32P囊内放疗或伽玛刀治疗；囊性为主复发者行立体定向囊液抽吸+32P囊内放疗，合并实体病变者结合伽玛刀治疗；病变体积小，未侵及下丘脑以及第三脑室的实体复发者采取开颅手术治疗；术后残余、复发实体病灶无法实施手术切除者行伽玛刀治疗。结果 开颅手术切除46例；采取立体定向囊液抽吸+32P囊内放疗32例，其中11例同时接受伽玛刀治疗；单独接受伽玛刀治疗5例。所有患者随访11~40个月，治疗有效75例，稳定4例，进展4例。并发症发生率为45.8%。结论 颅咽管瘤患者的治疗方案，应根据患者具体临床表现及影像学特征，个体化制定、实施。

Individualized treatment for craniopharyngiomas and analyses of typical cases

Objective To emphasize the importance of individualized treatment of craniopharyngioma and the indications of different treatment protocols. Methods The clinical data of 83 patients with craniopharyngioma were analyzed retrospectively including the individualized treatment and the following up data and so on. The indication and therapeutic effect of different treatment protocols were summarized. Different treatment protocols including gross total resection, partial resection combined with stereotactic intracavitary irradiation with 32P and stereotactic radiosurgery, stereotactic intracavitary irradiation with 32P as the initial treatment were applied to the patients with craniopharyngiomas. At the same time, appropriate and adequate hormone replacement therapy was given. Results The satisfactory curative effects were achieved. The gross total resection rate is 84.8% and the total response rate is 78.3%. The occurrence rate of complications is 45.8%. Conclusion The treatment of patients with craniopharyngiomas should be individually designed and carried out according to their clinical and radiographic characteristics.