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目的:探讨鞍区颅咽管瘤的手术入路选择及并发症防治措施。方法:对46例颅咽管瘤病人选用不同的手术入路切除肿瘤,其中经翼点颞下入路11例,额下入路(包括转终板入路)14例,胼胝体-透明膈间隙-穹隆间入路2例,经皮层侧脑室入路4例,经口鼻蝶(或单鼻孔)入路15例。结果:肿瘤全切除32例(69.6%),近全切除9例(19.6%),大部分切除5例(10.9%)。术后死亡1例。主要并发症:尿崩症18例(39.1%),电解质紊乱21例(45.7%)。结论:对颅咽管瘤病人选择合适的手术入路,有利于在直视下显露并全切除肿瘤;熟练地显微神经外科技术,熟悉鞍区的解剖关系并重视术中对下丘脑的保护,是降低术后并发症的重要环节。
Objective: To explore the choice of surgical approach for craniopharyngioma in sellar region and the prevention and treatment of complications. Methods: Forty-six patients with craniopharyngioma underwent surgical resection with different surgical approaches. Among them, 11 cases were treated by pterional approach and infratemporal approach, 14 cases were treated with frontal approach (including transflective approach), corpus callosum - There were 2 cases of intervertebral approach, 4 cases of transcortical lateral ventricle approach and 15 cases of oral and nasal butterfly (or single nostril) approach. Results: 32 cases (69.6%) underwent total resection, 9 cases (19.6%) underwent total resection and 5 cases (10.9%) underwent resection. One patient died after operation. The main complications: diabetes insipidus in 18 cases (39.1%), electrolyte imbalance in 21 cases (45.7%). Conclusion: Choosing the appropriate surgical approach for craniopharyngioma patients is conducive to revealing and total resection of the tumor under direct vision. Proficiency in microsurgical neurosurgery, familiar with the anatomy of the saddle area and emphasis on intraoperative protection of the hypothalamus , Is to reduce the postoperative complications of an important part.