眉弓入路显微手术治疗颅咽管瘤的临床应用及疗效

doi:10.13418/j.issn.1001-165x.2019.06.018

摘要/Abstract

摘要： 目的　分析眉弓入路显微手术治疗颅咽管瘤的临床效果及优势。方法　选择2016年3月~2018年3月于本院接受眉弓锁孔入路显微手术治疗的颅咽管瘤患者20例为观察组，2015年1月~2016年2月于本院接受经冠状额下入路手术治疗的颅咽管瘤患者15例为对照组。比较两组的手术指标、肿瘤切除完整、症状改善以及并发症等情况。结果　观察组手术时间、手术切口长度、住院时间均短于对照组，术野暴露程度满意度95.00%，高于对照组的66.67%（P<0.05），输血例数、治疗费用少于对照组。两组患者的颅咽管瘤全切除率比较，无统计学差异（P＞0.05）。出院随访3个月，观察组的头痛、内分泌症状改善效果优于对照组（P<0.05），而嗅觉障碍、视力减退、多尿症状比较，无统计学差异（P>0.05）。观察组患者的并发症发生率为20.00%，低于对照组的66.67%（P<0.05）。结论　经眉弓入路锁孔显微技术治疗颅咽管瘤，可获得良好的手术视野，脑组织损伤小，手术时间、住院时间较短，治疗费用、输血例数较少，头痛、内分泌症状明显改善，并发症发生率较低，值得推广。

关键词: 颅咽管瘤, 　眉弓锁孔入路显微手术, 　经冠状额下入路手术, 　并发症

Abstract: Objective To analyze the clinical effect and advantages of microsurgery of eyebrow arch for the treatment of patients with craniopharyngioma. Methods From March 2016 to March 2018, 20 patients with craniopharyngiomas who underwent microsurgical resection of eyebrow arch in our hospital were selected as the observation group; from January 2015 to February 2016, 15 patients with craniopharyngiomas who were treated with traditional coronary intervention in our hospital were selected as the control group. Clinical indicators, the integrity of tumor resection, clinical improvement, and complications were analyzed in both groups. Results The operation time, hospitalization time and length of surgical incision in the observation group were shorter than those in the control group, and the cost of treatment and the numbers of blood transfusion were less than those of the control group, the satisfaction degree of the field exposure was 95.00 %, which was statistically higher than the control group (66.67 %), P＜0.05. There was no statistical difference in the total resection rate of craniopharyngioma between the two groups. After 3 months of follow-up, the clinical manifestations of headache and endocrine symptoms in the observation group were better than those in the control group (P<0.05), while the olfactory disturbance, visual loss, and polyuria symptoms were not statistically different. The complication rate of the observation group was 20.00 %, which was lower than that of the control group (66.67 %), P<0.05. Conclusions The microscopic technique through the eyebrow arch can be used to minimally treat craniopharyngioma, which is worth promoting, because it can obtain a good surgical field of view, less damage to the brain tissue, shorter operation time and shorter hospital stay. The cost of treatment and the number of blood transfusions are also small. The headache and endocrine symptoms are significantly improved. The incidence of complications is low.

Key words: Craniopharyngiomas, Microsurgery of eyebrow arch and keyhole approach, Transfemoral approach, Complication

中图分类号:

R739.41

邓昭健, 蒋其俊, 甘正凯. 眉弓入路显微手术治疗颅咽管瘤的临床应用及疗效[J]. 中国临床解剖学杂志, 2019, 37(6): 704-707.

DENG Zhao-jian, JIANG Qi-jun, GAN Zheng-kai. Clinical application and effect of microsurgery through eyebrow arch for the treatment of craniopharyngioma[J]. Chinese Journal of Clinical Anatomy, 2019, 37(6): 704-707.

参考文献 18

[1]	伦鹏, 胥建, 吴泽玉, 等. 经眉弓眶上锁孔入路夹闭前循环动脉瘤[J]. 中华神经外科疾病研究杂志, 2016, 15(6): 497-500.
[2]	郑攀, 钱欢, 王恩任. 经眉弓锁孔入路夹闭前循环破裂动脉瘤[J]. 四川医学, 2017, 38(8): 921-924.
[3]	Dini LI, Isolan GR, Flores E, et al. Anterior skull base tumors: the role of transfacial approaches in the endoscopic era[J]. J Craniofac Surg, 2017, 29(1): 226-232.
[4]	濮彧, 范静平, 徐亚平, 等. 经眉弓和经额入路手术微创治疗前颅底病变的效果比较[J]. 医学综述, 2017, 23(21): 4361-4364.
[5]	田飞, 陈文荣, 杨文鹏, 等. 经眉弓眶上锁孔入路切除眶内肿瘤[J]. 中国临床医生杂志, 2016, 44(4): 67-70.
[6]	谭钧城. 早期显微手术夹闭治疗重症前交通动脉瘤并脑室出血的临床研究[J]. 实用医院临床杂志, 2018, 15(1): 171-174.
[7]	Farquhar D, Kim L, Worrall D, et al. Propensity score analysis of endoscopic and open approaches to malignant paranasal and anterior skull base tumor outcomes[J]. Laryngoscope, 2016, 126(8): 1724-1729.
[8]	王博, 杨智君, 李智, 等. 经眉弓眶上锁孔入路治疗脑脊液鼻漏的探讨[J]. 中国医药导报, 2016, 13(8): 68-71.
[9]	伦鹏, 陈兵, 窦以河, 等. 经眉弓眶上锁孔入路夹闭前交通动脉动脉瘤[J]. 中国微侵袭神经外科杂志, 2016, 21(8): 348-350.
[10]	张云龙, 孙传顺, 宋振声, 等. 无牵开器技术在经眉弓锁孔入路夹闭前循环动脉瘤手术的应用[J]. 中国微侵袭神经外科杂志, 2017, 22(11): 489-491.
[11]	Ercan S, Scerrati A, Wu P, et al. Is less always better? Keyhole and standard subtemporal approaches: evaluation of temporal lobe retraction and surgical volume with and without zygomatic osteotomy in a cadaveric model[J]. J Neurosurg, 2017, 127(1): 157-164.
[12]	王国良, 高寒, 张小鹏, 等. 89例垂体腺瘤的手术治疗体会[J]. 中国临床神经外科杂志, 2016, 21(7): 435-437.
[13]	兰青, 朱卿, 许亮, 等. 对侧入路夹闭颅内动脉瘤的手术探讨[J]. 中华神经外科杂志, 2016, 32(2): 112-116.
[14]	Iacoangeli M, Nocchi N, Nasi D, et al. Minimally invasive supraorbital key-hole approach for the treatment of anterior cranial fossa meningiomas[J]. Neurol Med Chir (Tokyo), 2016, 56(4): 180-185.
[15]	许志剑, 杨帆, 陈俊良, 等. 经眉弓眶上锁孔入路治疗丘脑出血破入脑室1例[J]. 浙江医学, 2018(4): 402-404.
[16]	Lucas JW, Zada G. Endoscopic endonasal and keyhole surgery for the management of skull base meningiomas[J]. Neurosurg Clin N Am, 2016, 27(2): 207-214.
[17]	荣亮, 胡玮. 不同术式治疗症状性Rathke囊肿的临床分析[J]. 中华生物医学工程杂志, 2017, 23(1):64-67.
[18]	陈安平, 潘开昌, 周宁全, 等. 翼点入路和眉弓锁孔入路对前交通动脉复合体显露的解剖学对比研究[J]. 国际神经病学神经外科学杂志, 2016, 43(6): 540-543.