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目的探讨大中型颅咽管瘤显微外科切除方法和术后并发症的防治。方法术前激素替代疗法,手术主要采用翼点入路,应用显微外科技术从鞍区各个手术间隙分块切除。术后严密观测患者的意识,尿量和血电解质,及时治疗。结果患者显微镜下肿块全切9例,大部分切除6例,术中放置Ommya囊4例,术后发生尿崩症13例,发生电解质紊乱11例,发生体温失衡5例,死亡1例。术后随访6个月～5年,4例复发。结论术前采用激素替代疗法,术中细致的操作应用及必要的辅助措施,术后积极处理并发症,可有效降低手术死亡率。
Objective To investigate the microsurgical resection and prevention of postoperative complications in large and medium craniopharyngiomas. Methods Preoperative hormone replacement therapy, the main approach using pterional approach, the application of microsurgical techniques from the saddle area of the surgical gap block removal. After careful observation of patients awareness, urine output and blood electrolytes, timely treatment. Results The patients underwent gross resection of the tumor in 9 cases, 6 cases of resection, 4 cases of Ommya sac in operation, 13 cases of diabetes insipidus after operation, 11 cases of electrolyte imbalance, 5 cases of body temperature imbalance and 1 case of death. The patients were followed up for 6 months to 5 years and 4 patients relapsed. Conclusion Preoperative hormone replacement therapy, intraoperative and meticulous operation and application of necessary support measures, postoperative treatment of complications, which can effectively reduce the operative mortality.