切除术和手术经验对颅咽管瘤患者存活率的影响:31例内窥镜经蝶手术系列。

Buruc Erkan, Ozan Barut, Ebubekir Akpinar, Mehmet Sait Cil, Suat Demir, Yusuf Kilic, Osman Tanriverdi, Esra Suheda Hatipoglu, Omur Gunaldi
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引用次数: 0

摘要

目的:分享在一个中心接受内窥镜鼻内镜经蝶手术(EETS)的31例患者的手术结果:这项回顾性分析对 31 例颅咽管瘤病例(2013-2022 年)进行了至少 6 个月的随访,包括人口统计学数据、术前检查结果、术后切除量、复发率、病理诊断和并发症:31名患者(12名男性,19名女性)接受了34例EETS手术。患者的主要症状包括视力下降(58%)、垂体功能减退(54.8%)和尿崩症(25.8%)。87%的患者实现了大体全切除,其中64.5%全切除,22.5%接近全切除。全切除术避免了复发,而次全切除术患者的复发率为75%(P=0.000)。原发性患者的全切除率为 73.1%,而复发性患者中只有 20% 实现了全切除(P=0.049)。将前 16 例与后 15 例的手术经验进行比较,后 15 例的切除率(p=0.040)和无复发生存率(p=0.020)均有统计学意义。术前视力下降的患者术后视力改善或稳定率为 94.4%。术后并发症包括垂体功能减退(71.4%)、永久性糖尿病(60.8%)、视力恶化(6.5%)、脑脊液漏(9.7%)、脑膜炎(6.5%),围手术期死亡率为 3.2%:本研究强调了手术切除在颅咽管瘤中的作用,并强调了手术经验对无复发生存率的影响。并发症少、切除范围大的初级手术对于应对复发挑战至关重要。内窥镜鼻内镜经蝶手术,尤其是在经验丰富的中心,具有全景视野和进入第三脑室底部等优势,有利于全切和近全切,延长无复发生存期。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effect of Resection and Surgical Experience on Survival in Patients with Craniopharyngiomas: Endoscopic Transsphenoidal Surgery in Series of 31 Cases.

Aim: To share the surgical outcomes of 31 patients who underwent endoscopic endonasal transsphenoidal surgery (EETS) at a single center.

Material and methods: This retrospective analysis of 31 craniopharyngioma cases (2013-2022) with a minimum 6-month follow-up included demographic data, preoperative findings, postoperative resection volumes, recurrence rates, pathological diagnoses, and complications.

Results: Herein, 34 EETS surgeries were performed on 31 patients (12 males, 19 females). The presenting symptoms included visual loss (58%), hypopituitarism (54.8%), and diabetes insipidus (25.8%). Gross total resection was achieved in 87% of the patients, with 64.5% total and 22.5% near-total resection. Total resection prevented recurrences, contrasting with 75% recurrence in the subtotal resection patients (p=0.000). The primary patients showed 73.1% total resection, while only 20% of the recurrent patients achieved it (p=0.049). When comparing the first 16 cases with the last 15 cases in terms of surgical experience, the rates of resection (p=0.040) and recurrence-free survival (p=0.020) in the last 15 cases were statistically significant. Patients with preoperative visual loss demonstrated 94.4% improvement or stability postoperatively. Postoperative complications included hypopituitarism (71.4%), permanent diabetes insipidus (60.8%), worsening vision (6.5%), cerebrospinal fluid leakage (9.7%), meningitis (6.5%), and a 3.2% perioperative mortality rate.

Conclusion: This study underscores the role of surgical resection in craniopharyngiomas, emphasizing the impact of surgical experience on recurrence-free survival. Primary surgery, with minimal complications and maximal resection, is crucial in managing recurrence challenges. Endoscopic endonasal transsphenoidal surgery, particularly in experienced centers, offers advantages such as panoramic vision and access to the third ventricle base, facilitating total and near-total resection and extending recurrence-free survival.

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