内镜经鼻斜坡肿瘤的外科治疗  

Endoscopic endonasai surgery for clival tumor

作　　者：张秋航[1] 孔锋[1] 严波[1] 倪志立[1] 吕海丽[1] 

机构地区：[1]首都医科大学宣武医院耳鼻咽喉头颈外科,100053

出　　处：《中华耳鼻咽喉头颈外科杂志》2007年第1期7-10,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的总结采用内镜经鼻入路外科治疗斜坡肿瘤的初步经验。方法 2002年8月至2005年11月,对24例斜坡病变患者行内镜经鼻手术,其中脊索瘤5例,骨纤维异常增殖症2例,脑膜瘤1例,颅咽管瘤1例,血管母细胞瘤1例,鳞状细胞癌6例,脊索肉瘤2例,软骨肉瘤2例,恶性淋巴瘤1例,腮腺癌颅底转移1例,甲状腺癌颅底转移1例,恶性骨巨细胞瘤1例。结果 24例患者术中镜下及术后影像学检查显示肿瘤完全切除22例,次全切除2例。所有病例随访12～51个月,有3例死亡。完全切除的22例中,术后5例复发,其中2例分别手术后5个月和43个月行第2次内镜经鼻手术,前者于第2次手术后26个月死亡,后者至今生仔。1例手术后18个月行经颅手术;2例分别于术后38个月和术后12个月复发,未行治疗,带瘤生存。次全切除的2例中,1例脊索肉瘤患者手术后3个月死亡;另1例术前曾行经颅手术,颅内中脑前方有瘤组织残留,手术后5个月死亡。术后并发症包括蛛网膜下腔出血1例、脑脊液鼻漏2例,无颅内感染病例。结论内镜经鼻治疗斜坡肿瘤不仅微创,而且可以更好地辨认深部结构,暴露和处理病变的范围大。同时,可以简单迅速地到达斜坡区域。内镜经鼻对于斜坡病变是一种较好的手术入路。Objective To review our experience with endoscopic endonasal approach for surgical management of clival tumors. Methods Twenty-four patients with clival tumors treated by endoscopic endonasal surgery between August 2002 and Novermber 2005 were studied prospectively. The operative technique was described in detail. There were 5 chordoma, 2 ossifying fibroma, 1 meningioma, 1 eraniopharyngioma, 1 hemangioblastoma, 6 squamous cancer, 2 chordosarcoma, 2 chondrosarcoma, 1 lymphoma, 1 malignant giant cell tumor and 2 metastatic carcinoma. Results Total tumor removal was obtained in 22 eases, subtotal removal in 2 case. Follow-up ranged 12 to 51 months. Three patients dead. Five patients with total removal recurred, one of them dead. Two patients with subtotal removal dead, one with chordosarcoma and one with chordoma. The complications included subarachnoid hemorrhage in 1 patient, and transient cerebrospinal leakage in 2 cases. Conclusions The use of nasoendoscope to perform clival tumor surgery is not only limited to the minimally invasive aspect, it also provides better visualization of deeper structures in the skull base, provides the ability to ‘ look around corners＇ and wide exposed field. This approach permits us to manage clival lesions properly.

关 键 词：内窥镜检查 颅底肿瘤 颅窝 后 耳鼻喉外科手术 

分 类 号：R739.62[医药卫生—肿瘤]