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目的探讨颅咽管瘤(CPG)全切除术的手术方法和术后并发症的防治措施。方法24例CPG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CPG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。
Objective To investigate the surgical treatment of craniopharyngioma (CPG) total resection and the prevention and treatment of postoperative complications. Methods 24 cases of CPG are located in the saddle area. Preoperative preparation mainly includes glucocorticoid replacement therapy and prevention of epilepsy. Surgery were taken pterional approach, the use of microscopic techniques from the saddle area of the surgical gap block removal of the tumor. Postoperative management includes close observation of patient awareness, urine output and serum electrolytes, timely prevention and treatment of diabetes insipidus, electrolyte disorders and other complications, prevention of epilepsy and glucocorticoid replacement therapy. Results Twenty-two patients underwent complete resection of the tumor under the microscope. There were a few residual tumors in the two cases and no obvious neurological dysfunction after operation. Diabetes insipidus occurred in 16 patients, electrolyte disturbances in 12 patients, and body temperature imbalance in 6 patients. After treatment, electrolyte imbalance and body temperature imbalance completely corrected, 13 cases of diabetes insipidus healed, 3 patients were relieved. Conclusion It is the key to complete total resection of CPG according to the most suitable surgical approach according to the extent of tumor expansion and to familiarize with the surgical gap dissection in the saddle area and make full use of it during operation. Preoperative glucocorticoid replacement therapy, postoperative close monitoring of urine output and blood electrolytes, active management of diabetes insipidus, electrolyte disorders and other complications, can effectively reduce the operative mortality.