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目的 评价立体定向囊内放疗治疗囊性颅咽管瘤患者的远期疗效.方法 回顾性纳入1996年1月至2015年12月在海军总医院神经外科行立体定向囊内P-32放射治疗的囊性颅咽管瘤患者141例,其中67例(47.5％)为术后复发者.囊壁累计计算的β射线照射剂量为250 Gy.评估患者的远期治疗结果.结果 随访1.0～19.5年,平均(9.7±4.5)年.视力下降的改善率为68.6％(59/86).141例患者中,肿瘤的有效控制率为86.5％(122例),其中完全有效率为44.0％(62例),部分有效率为36.2％(51例),稳定率为6.3％(9例);无效率为13.5％(19例);肿瘤复发率为17.0％(24例).141例中,随访期发生视力下降13例(9.2％),动眼神经麻痹2例(1.4％),颈内动脉闭塞1例(0.7％),新发性功能障碍5例(3.5％)、多饮多尿7例(5.0％)、肥胖12例(8.5％)、记忆力或认知功能下降10例(7.1％),远期总体并发症的发生率为35.5％(50/141).平均生存时间为120个月,5年、10年及15年实际生存率分别为97.9％ (138/141)、92.9％(131/141)及89.3％(126/141).结论 立体定向囊内放射治疗囊性颅咽管瘤,长期疗效较好.适用于手术风险高和术后复发的患者.

Objective To assess the long-term outcomes of stereotactic intracystic brachytherapy for the treatment of cystic craniopharyngiomas.Methods A total of 141 consecutive patients with cystic craniopharyngioma treated by stereotactic intracystic phosphorus-32 at Department of Neurosurgery,Navy General Hospital of PLA from January 1996 to December 2015.There were 85 males and 56 females and the mean age was 40.1 years (range:3-72 years).The calculated cumulative beta dose aimed at the inner surface of the cyst wall was 250 Gy.Results All patients were followed up for 1.0-19.5 years with an average of 9.7 ± 4.5 years.The decreased visual acuity had improved in 68.6％ (59/86) of the patients in long-term result.The total tumor response rate was 86.5％ (122 cases) including the total response accounting for 44.0％ (62 cases),partial response accounting for 36.2％ (51 cases) and stable response accounting for 6.3％ (9 cases).The rate of no response was 13.5％ (19 cases).The recurrence rate was 17％ (24 cases).The side effects that occurred during follow-up period included worsening of visual acuity in 13 (9.2％),the third nerve palsy in 2 (1.4％),internal carotid artery occlusion in 1(0.7％),new-onset sexual dysfunction in 5 (3.5％),diabetes insipidus in 7 (5.0％),obesity in 12 (8.5％) and cognitive dysfunction in 10 (7.1％) patients,respectively.The late complication rate was 35.5％ (50/141).The mean survival after treatment was 120 months.The actuarial 5-,10-and 15-yr survival rates were 97.9％ (138 cases),92.9％ (131 cases) and 89.3％ (126 cases),respectively.Conclusion Stereotactic intracavitary brachytherapy is a valuable treatment alternative for cystic craniopharyngioma,particularly for patients with high surgical risk and recurrent tumors.