神经内镜扩大经鼻蝶切除术与开颅术治疗颅咽管瘤的疗效

摘要

目的 分析神经内镜扩大经鼻蝶切除术(EETS)与开颅术切除颅咽管瘤的疗效.方法 回顾性分析2006年1月至2015年12月空军军医大学唐都医院神经外科手术治疗的颅咽管瘤患者的临床资料,共58例(68例次).其中开颅切除肿瘤38例次(开颅组),EETS切除30例次(EETS组).比较2组患者的肿瘤切除程度、并发症、复发率及无进展生存期.结果 两组患者的年龄、性别、肿瘤病理学分型、肿瘤质地、术前肿瘤体积等,差异均无统计学意义(均P ＞0.05).开颅组和EETS组的肿瘤全切除率分别为81.6％ (31/38)、80.0％ (24/30),垂体功能低下的发生率分别为36.8％ (14/38)、40.0％(12/30),尿崩症的发生率分别为47.4％(18/38)、33.3％ (10/30),脑积水的发生率分别为10.5％(4/38)、13.3％ (4/30),差异均无统计学意义(均P＞0.05).开颅组和EETS组脑神经损伤率分别为21.1％(8/38)、0％;脑脊液漏发生率分别为0％、23.3％(7/30),差异均有统计学意义(均P＜0.01).两组随访19～94个月,开颅组和EETS组复发率分别为18.4％(7/38)、20.0％(6/30),复发的中位时间分别为10.3个月和10.8个月,无进展生存期分别为25.4个月、26.4个月,差异均无统计学意义(均P＞0.05).结论 与开颅术相比,EETS能够达到相似的肿瘤切除程度及预后,能减少脑神经损伤的发生率,但脑脊液漏发生率相对较高.%Objective To discuss and analyze the outcomes,complications and progression-free survival of craniotomy and expanded endoscopic endonasal transsphenoidal surgery (EETS) of craniopharyngioma.Methods Clinical data of 58 patients with craniopharyngiomas were analyzed retrospectively who underwent 68 surgical operations at Department of Neurosurgery,Tangdu Hospital of the Air Force Medical University,from January 2006 to December 2015.Patients were separated into two groups including one group of patients underwent craniotomy (38 cases) and EETS was performed in the other group (30 cases).Intra-group comparison was conducted regarding the resection extent,complications,recurrence rate and progression-free survival.Results No significant difference was identified in the patient's age,gender,pathological classification,texture or preoperative volume of tumor between the two groups.The total resection rate of craniopharyngiomas in craniotomy group was 81.6％ and 80.0％ in EETS group (P =0.927).There was no significant difference in the incidence rate of panhypopituitarism (36.8％ vs.40.0％,P =0.81),diabetes insipidus (47.4％ vs.33.3％,P =0.32) or hydrocephalus (10.5％ vs.13.3％,P =0.53) between craniotomy and EETS groups.Cranial nerve injures were more commonly reported in craniotomy group than in EETS group (21.1％ vs.0％,P =0.007).The incidence rate of cerebrospinal fluid (CSF) leakage was significantly higher in EETS group than that in craniotomy group (23.3％ vs.0％,P=0.002).All patients were followed up for 19-94 months.There was no significant difference in the recurrence rate [18.4％ (7/38) vs.20.0％ (6/30)],median time to recurrence (10.3 months vs.10.8 months) or progression-free survival (25.4 months vs.26.4 months) between the craniotomy and EETS groups (all P ＞ 0.05).Conclusions The extent of craniopharyngioma resection and outcomes of patients in EETS are comparable to those in craniotomy.EETS seems to be associated with a lower incidence rate of cranial nerve injures and a higher incidence rate of CSF leakage.