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目的 探讨肿瘤生长方向与侵袭特征在大型颅咽管瘤手术中的意义。方法 根据63例大型颅咽管瘤影像学及手术所见,分别将肿瘤质地、肿瘤在鞍内、鞍上及下丘脑部位的形态及生长方向对手术的影响进行量化,分析量化结果与手术切除及术后反应的关系。结果 3组病人手术1～2级切除率有显著差异,评分越高,1～2级切除率越低,同时术后出现下丘脑反应的机会也越多。鞍内肿瘤的评分对估计术后鞍内肿瘤的残留有重要意义;而鞍上及下丘脑部位肿瘤的评分则更多地反映病人术后反应的严重程度。结论 根据肿瘤质地及肿瘤在鞍内、鞍上及下丘脑部位不同形态和侵袭特征进行综合评分,可以在术前、术中对肿瘤切除难易程度以及预后做出正确判断。
Objective To investigate the significance of tumor growth direction and invasion characteristics in large craniopharyngioma surgery. Methods According to the imaging and surgical findings of 63 cases of large craniopharyngioma, the effects of the tumor texture, tumor in the saddle, supraspinatus and hypothalamus on the operation were quantified, and the results of quantification and surgical resection were analyzed And postoperative response. Results There were significant differences in the resection rates of grade 1 ~ 2 in 3 groups of patients. The higher the score, the lower the resection rate of grade 1 ~ 2, and the more chance of hypothalamic reaction after operation. The assessment of intra-sellar tumors is important for the estimation of post-operative intra-tumoral tumor remnants, whereas the scores for supraspinatus and hypothalamic tumors more often reflect the severity of the postoperative response. Conclusions According to the tumor texture and the comprehensive evaluation of tumor morphology and invasion characteristics in the saddle, the suprasellar and hypothalamus, the right degree of tumor resection and prognosis can be correctly determined before and during surgery.