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目的探讨间质内放疗结合伽玛刀治疗颅咽管瘤的临床疗效。方法将我科自1996年收治的143例手术后残留或复发的颅咽管瘤患者予以立体定向囊内同位素置入间质内放疗结合伽玛刀治疗,其中实体肿瘤为主者,先行立体定向囊内穿刺同位素置入内放疗,再行伽玛刀照射治疗。囊性肿瘤为主者,先行实体部分肿瘤伽玛刀治疗,再行囊性部分的同位素内放疗。手术后观察所有患者的症状改善情况以及住院时间。对所有患者进行5年的随访观察,同时采用SF-36对患者的生活质量进行评价。结果所有患者的手术均获得成功。囊性部分行立体定向穿刺抽出囊液量为1.0~45.0ml,平均12.6ml;术后视力、视野均获得不同程度的好转,住院时间4~11d,平均7.2d。术后有32例(22.38%)发生不良反应,无严重并发症及手术死亡。128例(89.51%)患者接受12~56个月,平均28.6个月的随访,随访期内有7例(5.47%)患者接受了第二次伽玛刀治疗,18例(14.06%)患者接受了第二次间质内放疗,对实体肿瘤为主、囊性肿瘤为主以及总体有效控制率分别为95.3%、93.7%和92.1%。与治疗前比较,治疗后患者的各项生活质量指标均升高明显,差异有统计学意义(P<0.05)。结论伽玛刀结合立体定向囊内放射治疗治疗手术后残留或复发的囊实体混合性颅咽管瘤,不仅安全有效,而且可有效提高患者的生活质量,适宜临床推广。
Objective To investigate the clinical efficacy of interstitial radiotherapy combined with gamma knife in the treatment of craniopharyngioma. Methods The 143 patients with craniopharyngiomas who had residual or recurred after operation in our department from 1996 to 1996 were treated with stereotactic intracapsular isotope implantation of interstitial radiotherapy combined with gamma knife treatment. The main solid tumors were stereotactic Intracranial puncture isotope insertion radiotherapy, gamma knife irradiation treatment. Cystic tumor-based, the first part of the real part of the tumor gamma knife treatment, and then cystic part of the isotope radiotherapy. All patients were observed after surgery to improve the symptoms and hospital stay. All patients were followed up for 5 years, while the quality of life of patients with SF-36 evaluation. Results All patients underwent successful surgery. Cystic part of the stereotactic puncture capsule volume was 1.0 ~ 45.0ml, an average of 12.6ml; visual acuity, visual field were improved to varying degrees, hospitalization 4 ~ 11d, an average of 7.2d. There were 32 cases (22.38%) had adverse reactions after operation, no serious complications and surgical death. 128 (89.51%) patients were followed up for 12 to 56 months with an average of 28.6 months. During the follow-up period, 7 patients (5.47%) underwent gamma knife treatment and 18 patients (14.06% The second interstitial radiotherapy, mainly solid tumors, cystic tumors and the overall effective control rates were 95.3%, 93.7% and 92.1%. Compared with before treatment, the quality of life of patients after treatment were significantly increased, the difference was statistically significant (P <0.05). Conclusion Gamma knife combined with stereotactic intracapsular radiation therapy for residual or recurrent cystic craniopharyngioma after surgery is not only safe and effective, but also can effectively improve the quality of life of patients, suitable for clinical promotion.