手术治疗31例小儿颅咽管瘤临床分析

Surgical treatment of childhood craniopharyngioma: clinical analysis of 31 cases

摘要:

目的：为了提高对儿童颅咽管瘤的诊断率以及减少术后并发症的发生，该研究探讨小儿颅咽管瘤的诊断方法、手术方式及术后并发症的防治。方法：回顾性分析31例小儿颅咽管瘤的临床表现、手术方法和术后并发症治疗的经验。结果：31例患儿主要临床表现为：头痛，视力下降，生长发育迟缓等。CT和MRI可确诊颅咽管瘤。31例颅咽管瘤中，肿瘤全切除 19例（61.3%），次全切除5例（16.1%），大部分切除7例（22.6%）。术后出现尿崩症者19例（61.3%），3例为长期性尿崩。6例（19.4 %）出现下丘脑损伤症状。无死亡病例。随访32.5个月, 5例（16.1%）患儿复发。结论：小儿颅咽管瘤的诊断主要依据临床表现、CT和MRI检查，该病以开颅手术治疗为首选。肿瘤切除的程度应考虑降低肿瘤的复发和减少并发症的发生为原则。［中国当代儿科杂志，2009，11（8）：663-665］

Abstract:

OBJECTIVE: To study the diagnosis, surgical treatment and outcome of craniopharyngioma in 31 children.MethodsThe clinical data of 31 children (aged 7-14 years) with craniopharyngioma were studied retrospectively. RESULTS: Headache, visusal disorder and growth retardation were main manifestations in the 31 children. The 31 children were definitely diagnosed with craniopharyngioma by CT and MRI. In the 31 cases, 19 (61.3%) underwent total tumor removal, 5 (16.1%) subtotal removal, and 7 (22.6%) partial removal. After tumor removal, transient diabetes insipidus occurred in 19 cases (61.3%) and long-term diabetes insipidus in 3 cases. Six cases (19.4%) presented hypothalamic injuries after surgery. No patient died after surgery. Five patients (16.1%) had recurrent tumor in a mean follow-up of 32.5 months.ConclusionsThe diagnosis of childhood craniopharyngioma may be based on clinical manifestations and CT/MRI examinations. Craniotomy is a preferred surgical treatment. Proper extent of tumor resection should be determined in order to reduce the tumor recurrence and the incidence of postoperative complications.［Chin J Contemp Pediatr, 2009, 11 (8):663-665］